Iowa Administrative Bulletin

Inquiries may be sent to Michael L. Fitzgerald, Treasurer of State, State Capitol, Des Moines, Iowa 50319.

June 1, 1997 -- June 30, 1997 9.00%

July 1, 1997 -- July 31, 1997 8.75%

August 1, 1997 -- August 31, 1997 8.50%

September 1, 1997 -- September 30, 1997 8.25%

October 1, 1997 -- October 31, 1997 8.25%

November 1, 1997 -- November 30, 1997 8.25%

December 1, 1997 -- December 31, 1997 8.00%

January 1, 1998 -- January 31, 1998 8.00%

February 1, 1998 -- February 28, 1998 7.75%

March 1, 1998 -- March 31, 1998 7.50%

April 1, 1998 -- April 30, 1998 7.50%

May 1, 1998 -- May 31, 1998 7.75%

June 1, 1998 -- June 30, 1998 7.75%

July 1, 1998 -- July 31, 1998 7.75%

These amendments eliminate the requirement that the first $50 of assigned, current monthly child support collected and retained by the Department be paid to the FIP participant and provide Medicaid coverage under the Mothers and Children (MAC) coverage group to children, up to the age of 19, living in families with incomes that do not exceed 133 percent of the federal poverty level.

FIP participants will no longer get the payment (called "rebate") from assigned child support collected and retained for the month of July 1998 or any month thereafter. However, FIP participants who are currently eligible to receive rebates will be entitled to a rebate based on assigned support collected and retained for the month of June 1998 or earlier even though the payment may not be authorized until July 1 or later.

There is no change in the treatment of support received and retained by a FIP applicant or participant. The Department will not count the first $50 for FIP eligibility or benefits, as is done under current FIP rules. This promotes consistency between the FIP and FMAP-related medical programs.

Elimination of the rebate payment began July 1, 1997, as required by 1997 Iowa Acts, chapter 208, section 3, subsection 5. (See ARC 7321A in the July 2, 1997, Iowa Administrative Bulletin.) However, chapter 208 affected only those households which were approved for FIP on or after July 1, 1997. Households active on FIP on June 30, 1997, remained eligible for rebates until their FIP eligibility stopped. They could not get the rebate again if they later reapplied and were approved for FIP.

Consequently, these amendments affect only those households which have remained active on FIP since June 1997 and are thus eligible for rebates.

Increasing the income limit to 133 percent of the federal poverty level for all children up to the age of 19 will greatly simplify the Medicaid program and provide coverage to children who do not currently qualify for coverage. The current Medicaid income guidelines for children are based on the child's age and the family income. As a result of differing income thresholds for children, depending on their age, some children in a family may be eligible for Medicaid while others are not.

These amendments also clarify household composition issues created by increasing the income limit for all children up to the age of 19.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2410, section 5, subsection 5, and sections 9 and 80, and House File 2517, section 14, which authorize the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of these amendments should be waived and these amendments be made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2410, section 5, subsection 5, and sections 9 and 80, and House File 2517, section 14.

These amendments are also published herein under Notice of Intended Action as ARC 8118A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code sections 234.12, 239B.6, 249A.4, and 252B.3 and 1998 Iowa Acts, Senate File 2410, section 5, subsection 5 and House File 2517, section 9, subsection 1.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 441--41.22(239B) as follows:

Amend subrule 41.22(6), paragraph "b," subparagraph (4), as follows:

(4) Paying to the department any nonexempt cash support payments for a member of the eligible group, except as described at 41.27(7)"p" and "q," received by a recipient after the date of decision as defined in 441--subrule 40.24(4).

Amend subrule 41.22(7) by rescinding and reserving paragraph "b."

ITEM 2. Amend rule 441--41.27(239B) as follows:

Amend subrule 41.27(1), paragraph "h," subparagraph (1), as follows:

(1) Any nonexempt cash support payment, for a member of the eligible group, made while the application is pending, shall be treated as unearned income and deducted from the initial assistance grant(s). Any nonexempt cash support payment, for a member of the eligible group, except as described at 41.27(7)"p" and "q," received by the recipient after the date of decision as defined in 441--subrule 40.24(4), shall be refunded to the child support recovery unit.

Amend subrule 41.27(6), paragraph "u," as follows:

u. The first $50 representing received and retained by an applicant or recipient which represents a current monthly support obligation or a voluntary support payment, paid by a legally responsible individual, but in no case shall the total amount exempted exceed $50 per month per eligible group.

ITEM 3. Rescind and reserve rule 441--65.26(234).

ITEM 4. Amend rule 441--75.1(249A) as follows:

Amend subrule 75.1(15), paragraph "a," subparagraph (6), as follows:

(6) When a person is residing in a household in which some members are receiving FMAP under the provisions of subrule 75.1(14) or MAC under the provisions of subrule 75.1(28), and when the person is not included in the FMAP or MAC eligible group, the family size shall consist of the person and all other family members as defined above except those in the FMAP or MAC eligible group.

Amend subrule 75.1(28), introductory paragraph, as follows:

75.1(28) Pregnant women, infants and children (Mothers and Children (MAC)). Medicaid shall be available to all pregnant women, infants (under one year of age) and children, who were born after September 30, 1983, and who have not attained the age of 19, if the following criteria are met:

Further amend subrule 75.1(28), paragraph "a," subparagraph (1), as follows:

(1) Family income shall not exceed 185 percent of the federal poverty level for pregnant women when establishing initial eligibility under these provisions and for infants (under one year of age) when establishing initial and ongoing eligibility. Family income shall not exceed 133 percent of the federal poverty level for children who have attained one year of age but who have not attained six 19 years of age. Family income shall not exceed 100 percent of the federal poverty level for children who have attained six years of age but who have not attained 19 years of age. Income to be considered in determining eligibility for pregnant women, infants, and children shall be determined according to family medical assistance program (FMAP) methodologies except that the three-step process for determining initial eligibility and the two-step process for determining ongoing eligibility, as described at rule 441--75.57(249A), shall not apply. Family income is the income remaining after disregards and deductions have been applied in accordance with the provisions of rule 441--75.57(249A).

Further amend subrule 75.1(28), paragraph "a," by adding the following new subparagraphs (3), (4) and (5):

(3) Unless otherwise specified, when the person under the age of 19 is living with a parent or parents, the family size shall consist of all family members as defined by the family medical assistance program.

Application for Medicaid shall be made by the parents when the person is residing with them. A person shall be considered to be living with the parents when the person is temporarily absent from the parent's home as defined in subrule 75.53(4). If the person under the age of 19 is married or has been married, the needs, income and resources of the person's parents and any siblings in the home shall not be considered in the eligibility determination unless the marriage was annulled.

(4) When a person under the age of 19 is living with a spouse, the family size shall consist of that person, the spouse, and any of their children.

(5) Siblings under the age of 19 who live together shall be considered in the same filing unit for the purpose of establishing eligibility under this subrule unless one sibling is married or has been married, in which case the married sibling shall be considered separately unless the marriage was annulled.

Further amend subrule 75.1(28), paragraphs "f," "h," and "j," as follows:

f. An infant shall be eligible through the month of the first birthday unless the birthday falls on the first day of the month. A child shall be eligible through the month in which the child reaches the age of the maximum duration of eligibility allowed under this subrule of the nineteenth birthday unless the birthday falls on the first day of the month.

h. The When determining eligibility under this coverage group, the deprivation requirements as specified at subrule 75.54(3), living with a specified relative as specified at subrule 75.54(2), and the student provisions specified in rule 75.54(1) do not apply to children in this coverage group.

j. If an infant loses eligibility under this coverage group at the time of the first birthday due to an inability to meet the income limit for children or if a child loses eligibility at the time of the sixth nineteenth birthday due to an inability to meet the income limit for children under this subrule, but the infant or child is receiving inpatient services in a medical institution, Medicaid shall continue under this coverage group for the duration of the time continuous inpatient services are provided.

ITEM 5. Amend subrule 75.57(1), paragraph "e," introductory paragraph, as follows:

e. Support payments in cash shall be considered as unearned income in determining initial and continuing eligibility. The first $50 of assigned child support collected periodically which represents monthly support payments made by a legally responsible individual shall be paid to the client without affecting eligibility during the month.

ITEM 6. Amend rule 441--95.3(252B) as follows:

Amend subrule 95.3(1), paragraph "d," as follows:

d. Recipients of family investment assistance who are were approved to receive assistance prior to July 1, 1997, shall continue to be eligible to receive support rebates until they are no longer eligible for the family investment program, but shall not be eligible to receive support rebates upon reapplication and subsequent receipt of family investment program assistance only if the payment was collected for June 1998 or an earlier month based upon the date of collection as described in paragraphs "a" to "c" above and received after July 1, 1998. Recipients of family investment assistance approved on or after July 1, 1997, are not eligible to receive support rebates. The child support recovery unit shall authorize and terminate payment of support rebates based upon eligibility and reapplication approval determinations by for the family investment program by the income maintenance unit.

Amend subrule 95.3(4) as follows:

95.3(4) If a recipient is entitled to a support rebate as allowed in 95.3(1)"d," payment of up to $50 in assigned support to the family investment program recipient shall occur in the month in which the support collected equals or exceeds $50 of assigned support. If less than $50 is collected, payment shall be made in the month following the month in which the monthly support is applied to the child support account.

Amend the implementation sentence following rule 441--95.3(252B) as follows:

This rule is intended to implement Iowa Code sections 252B.3, 252B.4, and 252B.11 and 1997 Iowa Acts, House File 715, section 3, subsection 5 1998 Iowa Acts, Senate File 2410, section 5, subsection 5.

ARC 8117A

The Council on Human Services adopted this amendment June 10, 1998. Notice of Intended Action regarding this amendment was published in the Iowa Administrative Bulletin on May 6, 1998, as ARC 7967A.

This amendment increases the income eligibility guidelines for the Emergency Food Assistance Program.

Income eligibility guidelines for the Emergency Food Assistance Program in Iowa are based on the income guidelines for the reduced price meals in the National School Lunch Program. These guidelines are set at 185 percent of the federal poverty guidelines and are normally revised effective July 1 of each year. Revised federal poverty guidelines have been received.

The Department finds that this amendment confers a benefit to the public by increasing the income guidelines and allowing more needy individuals to be served under the program. Therefore, this amendment is filed pursuant to Iowa Code section 17A.5(2)"b"(2).

This amendment is identical to that published under Notice of Intended Action.

This amendment is intended to implement Iowa Code section 234.12.

This amendment became effective July 1, 1998.

The following amendment is adopted.

Amend subrule 73.4(3), paragraph "d," subparagraph (2), as follows:

(2) Income eligible status. The gross income according to family size is no more than the following amounts:

Household Size	Yearly Income		Monthly Income		Weekly Income
1	$14,597 $14,893		$1,217 $1,242		$ 281 $ 287
2	19,629 20,073		1,636 1,673		378 387
3	24,661 25,253		2,056 2,105		475 486
4	29,693 30,433		2,475 2,537		572 586
5	34,725 35,613		2,894 2,968		668 685
6	39,757 40,793		3,314 3,400		765 785
7	44,789 45,973		3,733 3,832		862 885
8	49,821 51,153		4,152 4,263		959 984
For each additional household member add:	$ 5,032 $ 5,180		$ 420 $ 432		$ 97 $ 100

ARC 8116A

These amendments require home health agencies participating in Medicaid to obtain, maintain, and timely file surety bonds. These bonds permit the Department to recover from a bonding company the amount of overpayments which are not repaid by a home health agency.

The Balanced Budget Act (BBA) of 1997 requires each home health agency to secure separate surety bonds in order to participate in both the Medicare and Medicaid programs. This requirement applies to all participating Medicare and Medicaid home health agencies, regardless of the date their participation began. Federal regulations were issued January 5, 1998, implementing the surety bond provisions retroactive to January 1, 1998. These regulations were rescinded on March 4, 1998. Modified regulations were published on June 1, 1998, to be effective July 1, 1998.

Home health agencies operated by a federal, state, local, or tribal government agency are exempt from the bonding requirements of the regulations if, during the preceding five years, the home health agencies have not had any uncollected overpayments. The regulations also require home health agencies entering the Medicare or Medicaid program on or after January 1, 1998, to demonstrate that they have available sufficient capital to start and operate for the first three months.

Under these amendments, the home health agencies currently participating in Medicaid which are not exempt are required to secure an initial surety bond for the period January 1, 1998, through the end of the home health agency's fiscal year and submit the bond to the Medicaid fiscal agent by September 29, 1998. New agencies are required to submit the bond with the application for Medicare certification.

Bonds for any period shall be in the amount of $50,000 or 15 percent of the home health agency's annual Medicaid payments during the most recently completed state fiscal year, whichever is greater. At least 90 days before the start of each home health agency's fiscal year, the Department shall provide notice of the amount of the surety bond to be purchased and submitted to the Medicaid fiscal agent.

The Department of Human Services finds that notice and public participation are impracticable because there is not time to allow for normal rule-making procedures and implement the federal regulations in a timely manner. The Department has no choice but to implement these regulations, which are required by federal law. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these amendments confer a benefit to the public by maintaining federal funding for the Iowa Medicaid program, by providing a source for repayment of Medicaid overpayments to home health agencies and, as determined by Congress, by combating home health fraud and abuse and protecting both users of home healthservices and the Medicaid program. Therefore, theseamendments are filed pursuant to Iowa Code section 17A.5(2)"b"(2).

These amendments are also published herein under Notice of Intended Action as ARC 8115A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code section 249A.4.

These amendments became effective June 10, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 441--77.9(249A) as follows:

441--77.9(249A) Home health agencies. Home health agencies are eligible to participate providing they are certified to participate in the Medicare program (Title XVIII of the Social Security Act) and, unless exempted under subrule 77.9(6), have submitted a surety bond as required by subrules 77.9(1) to 77.9(8).

77.9(1) Definitions.

"Assets" includes any listing that identifies Medicaid recipients to whom home health services were furnished by a participating or formerly participating home health agency.

"Rider" means a notice issued by a surety that a change in the bond has occurred or will occur.

"Uncollected overpayment" means a Medicaid overpayment, including accrued interest, for which the home health agency is responsible that has not been recouped by the department within 60 days from the date of notification that an overpayment has been identified.

77.9(2) Parties to surety bonds. The surety bond shall name the home health agency as the principal, the Iowa department of human services as the obligee and the surety company (and its heirs, executors, administrators, successors and assignees, jointly and severally) as surety. The bond shall be issued by a company holding a current Certificate of Authority issued by the U.S. Department of the Treasury in accordance with 31 U.S.C. Sections 9304 to 9308 and 31 CFR Part 223 as amended to November 30, 1984, Part 224 as amended to May 29, 1996, and Part 225 as amended to September 12, 1974. The bond shall list the surety's name, street address or post office box number, city, state and ZIP code. The company shall not have been determined by the department to be unauthorized in Iowa due to:

a. Failure to furnish timely confirmation of the issuance of and the validity and accuracy of information appearing on a surety bond that a home health agency presents to the department that shows the surety company as surety on the bond.

b. Failure to timely pay the department in full the amount requested, up to the face amount of the bond, upon presentation by the department to the surety company of a request for payment on a surety bond and of sufficient evidence to establish the surety company's liability on the bond.

c. Other good cause.

The Department shall give public notice of a determination that a surety company is unauthorized in Iowa and the effective date of the determination by publication of a notice in the newspaper of widest circulation in each city in Iowa with a population of 50,000 or more. A list of surety companies determined by the department to be unauthorized in Iowa shall be maintained and shall be available for public inspection by contacting the division of medical services of the department. The determination that a surety company is unauthorized in Iowa has effect only in Iowa and is not a debarment, suspension, or exclusion for the purposes of Federal Executive Order No. 12549.

77.9(3) Surety company obligations. The bond shall guarantee payment to the department, up to the face amount of the bond, of the full amount of any uncollected overpayment, including accrued interest, based on payments made to the home health agency during the term of the bond. The bond shall provide that payment may be demanded from the surety after available administrative collection methods for collecting from the home health agency have been exhausted.

77.9(4) Surety bond requirements. Surety bonds secured by home health agencies participating in Medicaid shall comply with the following requirements:

a. Effective dates and submission dates.

(1) Home health agencies participating in the program on June 10, 1998, shall secure an initial surety bond for the period January 1, 1998, through the end of the home health agency's fiscal year or a continuous bond which remains in effect from year to year and submit the bond to the Medicaid fiscal agent by September 29, 1998.

(2) Home health agencies seeking to participate in Medicaid and Medicare for the first time after June 10, 1998, shall secure an initial surety bond for the period from Medicaid certification through the end of the home health agency's fiscal year or a continuous bond which remains in effect from year to year and submit the bond with the application for Medicare certification.

(3) Medicare-certified home health agencies seeking to participate in Medicaid for the first time after June 10, 1998, shall secure an initial surety bond for the period from Medicaid certification through the end of the home health agency's fiscal year or a continuous bond which remains in effect from year to year and submit the bond with the enrollment application to the Medicaid fiscal agent.

(4) Home health agencies seeking to participate in Medicaid after purchasing the assets of or an ownership interest in a participating or formerly participating agency shall secure an initial surety bond effective as of the date of purchase of the assets or the transfer of the ownership interest, for the balance of the current fiscal year of the home health agency or a continuous bond which remains in effect from year to year.

(5) Home health agencies which continue to participate in Medicaid after the period covered by an initial surety bond shall secure a surety bond for each subsequent fiscal year of the home health agency or a continuous bond which remains in effect from year to year and shall submit each annual bond or any rider to a continuous bond to the Medicaid fiscal agent at least 30 days before the start of the fiscal year the annual bond covers or the effective date of the rider to a continuous bond.

b. Amount of bond. Bonds for any period shall be in the amount of $50,000 or 15 percent of the home health agency's annual Medicaid payments during the most recently completed state fiscal year, whichever is greater. After June 1, 2005, all bonds shall be in the amount of $50,000. At least 90 days before the start of each home health agency's fiscal year, the department shall provide notice of the amount of the surety bond to be purchased and submitted to the Medicaid fiscal agent.

c. Other requirements. Surety bonds shall meet the following additional requirements. The bond shall:

(1) Guarantee that upon written demand by the department to the surety for payment under the bond and the department's furnishing to the surety sufficient evidence to establish the surety's liability under the bond, the surety shall within 60 days pay the department the amount so demanded, up to the stated amount of the bond.

(2) Provide that the surety's liability for uncollected overpayments is based on overpayments determined during the term of the bond.

(3) Provide that the surety's liability to the department is not extinguished by any of the following:

1. Any action by the home health agency or the surety to terminate or limit the scope or term of the bond unless the surety furnishes the department with notice of the action not later than 10 days after the date of notice of the action by the home health agency to the surety and not later than 60 days before the effective date of the action by the surety.

2. The surety's failure to continue to meet the requirements in subrule 77.9(2) or the department's determination that the surety company is an unauthorized surety under subrule 77.9(2).

3. Termination of the home health agency's provider agreement.

4. Any action by the department to suspend, offset, or otherwise recover payments to the home health agency.

5. Any action by the home health agency to cease operations, sell or transfer any assets or ownership interest, file for bankruptcy, or fail to pay the surety.

6. Any fraud, misrepresentation, or negligence by the home health agency in obtaining the surety bond or by the surety (or the surety's agent, if any) in issuing the surety bond; except that any fraud, misrepresentation, or negligence by the home health agency in identifying to the surety (or the surety's agent) the amount of Medicaid payments upon which the amount of the surety bond is determined shall not cause the surety's liability to the department to exceed the amount of the bond.

7. The home health agency's failure to exercise available appeal rights under Medicaid or assign appeal rights to the surety.

(4) Provide that if a home health agency fails to furnish a bond following the expiration date of an annual bond or if a home health agency fails to furnish a rider for a year in which a rider is required or if the home health agency's provider agreement with the department is terminated, the surety shall remain liable under the most recent annual bond or rider to a continuous bond, for two years from the date the home health agency was required to submit the annual bond or rider to a continuous bond or for two years from the termination date of the provider agreement.

(5) Provide that actions under the bond may be brought by the department or by an agent designated by the department.

(6) Provide that the surety may appeal department decisions.

77.9(5) Failure to obtain, maintain, or timely file a surety bond. The department shall terminate or refuse to enter into a provider agreement with a home health agency that fails to obtain, timely file, or maintain a surety bond in compliance with this rule. The department shall provide written notice of the termination of or refusal to enter into a provider agreement with a home health agency that has failed to obtain, timely file, or maintain a surety bond in compliance with this rule. The home health agency may appeal the adverse action pursuant to 441--Chapter 7.

77.9(6) Exemption from surety bond requirements for government-operated home health agencies. A home health agency operated by a federal, state, local, or tribal government agency is exempt from the bonding requirements of this rule if, during the preceding five years, the home health agency has not had any uncollected overpayments.Government-operated home health agencies having uncollected overpayments during the preceding five years shall not be exempted from the bonding requirements of this rule.

77.9(7) Government-operated home health agency that loses its exemption. A government-operated home health agency which has met the criteria for an exemption under subrule 77.9(6) but is later determined by the department to not meet the criteria shall submit a surety bond within 60 days of the date of the department's written notification to the home health agency that it no longer meets the criteria for an exemption, for the period and in the amount required in the notice from the department.

77.9(8) Change of surety. A home health agency that secures a replacement surety bond from a different surety to cover the remaining term of a previously obtained bond shall submit the replacement surety bond to the Medicaid fiscal agent prior to the expiration date of the bond to be replaced.

ITEM 2. Amend rule 441--78.9(249A), introductory paragraph, as follows:

441--78.9(249A) Home health agencies. Payment shall be approved for medically necessary home health agency services prescribed by a physician in a plan of home health care provided by a Medicare-certified home health agency which has provided the surety bond required in rule 441-- 77.9(249A) for the home health agency's fiscal year.

ARC 8114A

These amendments implement the following changes to the Medicaid program mandated by the Seventy-seventh General Assembly:

* All of the reimbursement rates for the following noninstitutional providers are increased by 2 percent: ambulances, area education agencies, audiologists, birth centers, certified registered nurse anesthetists, family planning clinics, family or pediatric nurse practitioners, genetic consultation clinics, lead inspection agencies, maternal health centers, nurse-midwives, opticians, optometrists, orthopedic shoe dealers, physical therapists, podiatrists, psychologists, rehabilitation agencies, and screening centers.

* The reimbursement rates for chiropractors; dentists; durable medical equipment, prosthetic devices, and medical supply dealers; hearing aid dealers; and physicians will be increased a total of 2 percent. The Department will decide which procedure codes will be increased in consultation with provider representatives, placing a priority on primary and preventive care.

Dentists will also receive another 2 percent increase in January of 1999.

* Clinic rates will increase by 2 percent based on increases in the physician fee schedule.

* Community mental health centers rates will increase by 18.85 percent to the level paid by Medicare and private third-party payors.

* Home health agency providers, including Home- and Community-Based Service (HCBS) waiver home health providers, will be paid the maximum Medicare rate not to exceed the rate in effect on June 30, 1998, plus 2 percent. No other waiver providers will receive an increase.

* Independent laboratories will receive the maximum Medicare rate.

* Intermediate Care Facility for the Mentally Retarded (ICF/MR) rates will be established at the eightieth percentile of costs based on data from the December 31, 1997, cost reports.

* The reimbursement rate for skilled nursing care providers is increased by 2 percent subject to the maximum payment rate for the type of facility.

* The reimbursement rate for psychiatric medical institutions for children is increased by 2 percent.

* The maximum reimbursement rate for nursing facilities is increased by changing the maximum from the seventieth percentile of facility costs based on 1997 cost reports to the same percentile based on 1998 cost reports.

The Seventy-seventh General Assembly in 1998 Iowa Acts, Senate File 2410, section 32, subsection 1, paragraph "f," directed that the maximum reimbursement rate for nursing facilities should be adjusted effective July 1, 1998. It is estimated the maximum Medicaid nursing facility rate will increase from $71.70 to $76.13 effective July 1, 1998.

The Seventy-seventh General Assembly in 1997 Iowa Acts, chapter 208, section 28, subsection 1, paragraph "f," directed that if funds were available, the maximum reimbursement rate for nursing facilities should be adjusted effective January 1, 1998. It has not yet been determined if funding will be available to make this adjustment. The state cost for providing this increase for the last six months of the fiscal year is estimated at approximately 1.2 million dollars (state share $435,000) based on a $73.21 maximum daily rate. It is anticipated this decision will not be made until August.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2410, section 32, subsection 1, paragraphs "a," "e," "f," "h," "i," and "j," subsection 11, and subsection 14, and section 80, which authorize the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of these amendments should be waived and these amendments be made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2410, section 80.

These amendments are also published herein under Notice of Intended Action as ARC 8113A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code section 249A.4 and 1998 Iowa Acts, Senate File 2410, section 32, subsection 1, paragraphs "a," "e," "f," "h," "i," and "j," and subsection 11.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 79.1(2), Basis of reimbursement provider categories of "Ambulance," "Area education agencies," "Audiologists," "Birth centers," "Certified registered nurse anesthetists," "Chiropractors," "Community mental health centers," "Dentists," "Durable medical equipment, prosthetic devices and medical supply dealers," "Family planning clinics," "Family or pediatric nurse practitioner," "Genetic consultation clinics," "HCBS AIDS/HIV home health aide waiver service providers," "HCBS elderly home health aide waiver service providers," "HCBS ill and handicapped home health aide waiver service providers," "HCBS MR home health aide waiver service providers," "Hearing aid dealers," "Home health agencies," "Independent laboratories," "Intermediate care facilities for the mentally retarded," "Lead inspection agency," "Maternal health centers," "Nurse-midwives," "Nursing facilities," "Opticians," "Optometrists," "Orthopedic shoe dealers," "Physical therapists," "Physicians," "Podiatrists," "Psychiatric medical institutions for children," "Psychologists," "Rehabilitation agencies," and "Screening centers," as follows:

Provider category	Basis of reimbursement	Upper limit
Ambulance	Fee schedule	Ground ambulance: Fee schedule in effect 6/30/90 6/30/98 plus 2%. Air ambulance: A base rate of $200 $204 plus $7.50 $7.65 per mile for each mile the patient is carried.
Area education agencies	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 2%
Audiologists	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 2%
Birth centers	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 7.44% 2% for obstetrical service
Certified registered nurse anesthetists	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 1.6% 2%
Chiropractors	Fee schedule	Fee schedule in effect 4/1/98 6/30/98 plus targeted increases*
Community mental health centers	Fee schedule	Reimbursement rate for center in effect 6/30/90 6/30/98 plus 2% 18.85%
Dentists	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 2% and 2% effective 1/1/99*
Durable medical equipment, prosthetic devices and medical supply dealers	Fee schedule. See 79.1(4)	Fee schedule in effect 6/30/90 6/30/98 plus up to 6.4% targeted increases*
Family planning clinics	Fee schedule	Fees as determined by the physician fee schedule in effect 6/30/98 plus 2%
Family or pediatric nurse practitioner	Fee schedule	Fee schedule in effect 6/30/94 6/30/98 with the exception that screening services are fee schedule in effect 6/30/94 plus 5% 2%
Genetic consultation clinics	Fee schedule	Reimbursement rate for clinic in effect 6/30/90 6/30/98 plus 2%
HCBS AIDS/HIV waiver service providers, including:
2. Home health aides	Agency's financial and statistical cost report and Medicare percentage rate per visit Retrospective cost-related	Cannot exceed Medicare percentage rate per visit Maximum Medicare rate in effect on 6/30/98 plus 2%
HCBS elderly waiver service providers, including:
3. Home health aides	Retrospective cost-related	Maximum Medicare rate in effect on 6/30/98 plus 2%
HCBS ill and handicapped waiver service providers, including:
2. Home health aides	Agency's financial and statistical cost report and Medicare percentage rate per visit Retrospective cost-related	Cannot exceed Medicare percentage rate per visit Maximum Medicare rate in effect on 6/30/98 plus 2%
HCBS MR waiver service providers, including:
5. Home health aides	Retrospective cost-related	Maximum Medicare rate in effect on 6/30/98 plus 2%
Hearing aid dealers	Fee schedule plus product acquisition cost	Reimbursement rate for provider in effect 6/30/90 plus 2% plus up to 3.2% for materials Fee schedule in effect 6/30/98 plus targeted increases*
Home health agencies
(Encounter services-intermittent services)	Retrospective cost-related	Maximum Medicare rate in effect on 6/30/98 plus 2%
(Private duty nursing or personal care and VCF vaccine administration for persons aged 20 and under)	Interim fee schedule with retrospective cost settling based on Medicare methodology	Retrospective cost settling according to Medicare methodology not to exceed the rate in effect on 6/30/98 plus 2%
Independent laboratories	Fee schedule. See 79.1(6)	Fee Medicare fee schedule in effect 6/30/90 plus 2%. See 79.1(6)
Intermediate care facilities for the mentally retarded	Prospective reimbursement. See 441--82.5(249A)	Eightieth percentile of facility costs as calculated from 12/31/93 12/31/97 cost reports
Lead inspection agency	Fee schedule	Fee schedule in effect 6/30/98 plus 2%
Maternal health centers	Reasonable cost per procedure on a prospective basis as determined by the department based on financial and statistical data submitted annually by the provider group	Reasonable cost in effect 6/30/91 as determined by the department Fee schedule in effect 6/30/98 plus 2%
Nurse-midwives	Fee schedule	Fee schedule in effect 6/30/95 6/30/98 plus 5% 2%
Nursing facilities:
1. Nursing facility care	Prospective reimbursement. See 441--subrule 81.10(1) and 441--81.6(249A)	Seventieth percentile of facility costs as calculated from 6/30/97 6/30/98 cost reports
2. Skilled nursing care providers, including:
Hospital-based facilities	Prospective reimbursement. See 79.1(9)	Facility base rate per diems used on 6/30/97 6/30/98 inflated by 3.3% 2% subject to maximum payment rate at the sixtieth percentile of costs of all hospital-based skilled facilities
Freestanding facilities	Prospective reimbursement. See 79.1(9)	Facility base rate per diems used on 6/30/97 6/30/98 inflated by 3.3% 2% subject to maximum payment rate at the sixty-ninth percentile of costs of all freestanding skilled facilities
Opticians	Fee schedule. Fixed fee for lenses and frames; other optical materials at product acquisition cost	Reimbursement rate for provider in effect 6/30/90 6/30/98 for professional services plus 2% plus up to 3.2% for optometric products*
Optometrists	Fee schedule. Fixed fee for lenses and frames; other optical materials at product acquisition cost	Reimbursement rate for provider in effect 6/30/90 6/30/98 for professional services plus 2% plus up to 3.2% for optometric products*
Orthopedic shoe dealers	Fee schedule	Reimbursement rate for provider in effect 6/30/90 6/30/98 plus 2% plus up to 3.2% for materials*
Physical therapists	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 2%
Physicians (doctors of medicine or osteopathy)	Fee schedule. See 79.1(7)	Fee schedule in effect 6/30/90 6/30/98 plus 1.6% with the exception of obstetrical services as defined by the department and pediatric primary care services as defined by the department. targeted increases* Pediatric services will receive a 10% increase over the fee schedule in effect on 6/30/92. Obstetrical services will receive a 5% increase over the rates in effect 6/30/95. EPSDT screening services will receive a 5% increase over the rates in effect 6/30/94. The department may revise the fee schedule.
Podiatrists	Fee schedule	Fee schedule in effect 6/30/90 6/30/98 plus 2%
Psychiatric medical institutions for children
(Inpatient)	Prospective reimbursement	Reimbursement rate for provider in effect 6/30/97 6/30/98 plus 3% 2% to a maximum of $131.12 $133.74 per day
(Outpatient day treatment)	Fee schedule	Fee schedule in effect 6/01/93 6/30/98 plus 2%
Psychologists	Fee schedule	Reimbursement rate for provider in effect 6/30/90 6/30/98 plus 2%
Rehabilitation agencies	Retrospective cost-related	Reimbursement rate for agency in effect 6/30/90 6/30/98 plus 2%
Screening centers	Fee schedule	Reimbursement rate for center in effect 6/30/94 6/30/98 plus 5% 2%

Further amend subrule 79.1(2) by rescinding the footnote at the end of the chart and inserting the following new footnote:

*As required by 1998 Iowa Acts, Senate File 2410, section 32, subsection 1, paragraph "j," the department, in consultation with provider representatives, shall allocate to targeted services the 2 percent increase in overall rates paid to chiropractors, dentists, durable medical equipment dealers, and physicians, placing a priority on primary and preventative care. The department will also allocate to targeted services the 2 percent increase in rates for hearing aid dealers provided by 1998 Iowa Acts, Senate File 2410, section 32, subsection 1, paragraph "i," placing a priority on primary and preventative care.

ITEM 2. Amend subrule 81.6(16), paragraph "e," as follows:

e. Effective January 1, 1997, the basis for establishing the maximum reimbursement rate for non-state-owned nursing facilities shall be the seventieth percentile of participating facilities' per diem rates as calculated from the December 31, 1996, report of "unaudited compilation of various costs and statistical data."

Beginning July 1, 1997 1998, the basis for establishing the maximum reimbursement rate for non-state-owned nursing facilities shall be the seventieth percentile of participating facilities' per diem rates as calculated from the June 30, 1997 1998, report of "unaudited compilation of various costs and statistical data."

ARC 8111A

These amendments remove the requirement that an individual must have previously resided in a nursing facility or an intermediate care facility for persons with mental retardation (ICF/MR) in order to receive supported employment services under the home- and community-based waivers for persons with mental retardation or a brain injury.

This change is possible because the federal government lifted the requirement to have residency in a nursing facility or ICF/MR and the Seventy-seventh General Assembly mandated the change contingent upon federal approval.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2410, section 7, subsection 13, and section 80, which authorizes the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of these amendments should be waived and these amendments be made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2410, section 80.

These amendments are also published herein under Notice of Intended Action as ARC 8110A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code section 249A.4 and 1998 Iowa Acts, Senate File 2410, section 7, subsection 13.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 83.61(1), paragraph "g," by rescinding and reserving subparagraph (2).

ITEM 2. Amend subrule 83.82(2) by rescinding and reserving paragraph "b."

ARC 8109A

These amendments increase the time in which PROMISE JOBS participants are considered eligible to receive postsecondary educational funding from 24 to 36 consecutive months as mandated by the Seventy-seventh General Assembly in 1998 Iowa Acts, Senate File 2410, section 5, subsection 1, paragraph "g." This change is effective for family investment agreements entered into on or after July 1, 1996. Prior to this change, participants could lose eligible months of potential funding because they were allowed only 24 consecutive months to use up 24 months of funding eligibility. Therefore, participants who had to miss a semester of school due to family emergencies or who could not attend summer school could find themselves unable to complete their training program.

In addition, these amendments update statutory references.

The Department of Human Services finds that notice and public participation are unnecessary and impracticable. The General Assembly has mandated these changes and there is not time to allow for notice and public participation before July 1, 1998, at which time the 24 consecutive months is up for family investment agreements entered into on July 1, 1996. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these amendments confer a benefit on PROMISE JOBS participants in secondary education. This change will allow participants and the PROMISE JOBS program to develop self-sufficiency plans that will help participants complete their postsecondary training within a reasonable length of time while allowing some flexibility to accommodate family circumstances. Updating of statutory references will eliminate confusion on the part of the public. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)"b"(2).

These amendments are also published herein under Notice of Intended Action as ARC 8108A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code Supplement sections 239B.17 to 239B.22 and 1998 Iowa Acts, Senate File 2410, section 5, subsection 1, paragraph "g."

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend 441--Chapter 93 by revising the parenthetical implementation statutes "239" and "249C" to "239B" wherever they appear.

ITEM 2. Amend subrule 93.114(15) as follows:

93.114(15) Maximum limit on PROMISE JOBS funding. Notwithstanding subrules 93.114(1) through 93.114(14), any participant who develops one or more FIAs on or after July 1, 1996, that include approvable postsecondary vocational classroom training shall be eligible for consideration for PROMISE JOBS expenses allowable under these rules for no more than 24 consecutive months within a 36-consecutive-month period. Except for this funding limit, all other policies at subrules 93.114(1) to 93.114(14) apply, including the established time frames described in 93.114(3) and 93.114(14)"g," for including postsecondary vocational classroom training in the FIA, without requiring other FIA activities.

a. For purposes of this subrule, an FIA is considered to be developed when it is signed by a FIP participant who has never before signed an FIA or who must sign another FIA because FIP eligibility has been reestablished after FIP reapplication with a break in FIP assistance of more than one month.

b. The period of 24 36 consecutive months begins with the first month that the participant is eligible for consideration for PROMISE JOBS expense allowances. It is not altered by breaks in FIP assistance or breaks from the postsecondary vocational classroom training activity.

c. The period of 24 months of eligibility for PROMISE JOBS expense allowances under these rules begins with the first month that the participant is eligible for consideration for PROMISE JOBS expense allowances. A month is considered funded even if no allowance is issued due to educational financial awards policies as described at paragraph 93.114(10)"c" or because the client has no expense in a month.

ITEM 3. Amend the implementation sentence following 441--Chapter 93 as follows:

These rules are intended to implement 1997 Iowa Acts, Senate File 516, sections 18 to 23 Iowa Code Supplement sections 239B.17 to 239B.22.

ITEM 4. Amend 441--Chapter 94 by revising the parenthetical implementation statutes "77GA,SF516" and "249C" to "239B" wherever they appear.

ITEM 5. Amend rule 441--94.10(77GA,SF516) as follows:

441--94.10(239B) Maximum limit on ITADEC funding. FIP participants eligible for ITADEC who developed one or more PROMISE JOBS FIAs on or after July 1, 1996, shall be eligible for consideration for allowances for direct education costs allowable under these rules for no more than 24 consecutive months within a 36-consecutive-month period of PROMISE JOBS and ITADEC combined.

For purposes of this rule, an FIA is considered to be developed when it is signed by a FIP participant who has never before signed an FIA or who must sign another FIA because FIP eligibility has been reestablished after FIP reapplication with a break in FIP assistance of more than one month.

The period of 24 36 consecutive months begins with the first month that the participant was eligible for consideration for PROMISE JOBS expense allowances. It is not altered by breaks in FIP assistance or breaks from the postsecondary vocational classroom training activity.

The period of 24 months of eligibility for ITADEC or PROMISE JOBS expense allowances under these rules begins with the first month that the participant is eligible for consideration for PROMISE JOBS expense allowances. A month is considered ITADEC-funded or PROMISE JOBS-funded even if no allowance is issued because the client has no expense in a month or due to educational financial awards policies as described at rule 441--94.4(77GA,SF516) 441-- 94.5(239B) above or similar policies previously in effect under the PROMISE JOBS program.

ITEM 6. Amend the implementation sentence following 441--Chapter 94 as follows:

These rules are intended to implement 1997 Iowa Acts, Senate File 516, sections 18 to 23 Iowa Code Supplement sections 239B.17 to 239B.22.

ARC 8107A

These amendments lower the percentage withheld for a child support delinquency from 50 percent of the current support obligation to 20 percent for support orders entered or modified on or after July 1, 1998, and for support orders entered or modified prior to July 1, 1998, for which no income withholding order has been filed by an Iowa Child Support Recovery Unit (CSRU) prior to July 1, 1998. In addition, rounding up to the nearest dollar is removed from the income withholding process.

The Seventy-seventh General Assembly, in 1998 Iowa Acts, Senate File 2313, required the Department to decrease the amount of income withheld for the payment of delinquent support on a prospective basis from the current level of 50 percent of the current support obligation.

Before deciding on the change to 20 percent, CSRU looked at different options, including different percentages, a sliding scale based upon the income of the obligor, and a sliding scale based upon the obligation of the obligor. It was determined that a flat percentage was the best method of collection. A sliding scale based upon the obligation would be very complicated to maintain accurately. A sliding scale based upon the income of the obligor would place the burden of determining the amount to withhold for the payment on the arrears entirely upon the employer, and monitoring employer compliance would be very difficult.

This change will allow CSRU to bring the total amount of the income withholding order to a lower, more affordable amount for the obligor. Forty percent of all current income withholding orders containing arrearage provisions are collected at a rate from 95 percent to 125 percent of the current support. This is strong evidence of the amount obligors are able to pay. This change should encourage obligors to remain at jobs longer rather than "job hop" or move to the underground economy, where attachment of wages is very difficult. Therefore, it is projected that the net amount of support paid to families will increase. In addition, CSRU will be reviewing the underlying support award at the same time the income withholding reduction is implemented, and it is anticipated that a number of awards will increase.

Obligors who receive a new income withholding order for the collection of delinquency on or after July 1, 1998, shall pay 20 percent of current support toward liquidation of the delinquency rather than the current rate of 50 percent. Already existing income withholding orders shall be adjusted only when CSRU initiates a review of the obligation on the case. Upon completion of the review, CSRU may adjust any existing income withholding order for both current and arrears to the new amounts, even if a new obligation amount is not set. CSRU will adjust the income withholding order amounts if the obligor requests a review and there is an adjustment in the underlying obligation. If the obligor requests a review and there is no change in the underlying support amount, the income withholding order shall remain at the 50 percent level.

The removal of the rounding provision contained in the rules was done at the request of both obligors and obligees who have expressed frustration in having and receiving amounts withheld that are different from the underlying support award.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2313, section 45, which authorizes the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of these amendments should be waived and these amendments made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2313, section 45.

These amendments are also published herein under Notice of Intended Action as ARC 8106A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code chapter 252D and 1998 Iowa Acts, Senate File 2313, section 45.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 441--98.24(252D) as follows:

Amend subrule 98.24(1), introductory paragraph, as follows:

98.24(1) Current support obligation exists. When a current support obligation exists, the amount withheld shall be an amount equal to the current support obligation, and an additional amount equal to 50 percent of the current support obligation (rounded up to the nearest dollar) to be applied toward the liquidation of any delinquency.

Effective July 1, 1998, the amount withheld to be applied toward the liquidation of any delinquency shall be 20 percent of the current support obligation for any support order entered or modified on or after July 1, 1998, or for any support order entered or modified prior to July 1, 1998, for which no income withholding order has been filed by an Iowa CSRU prior to July 1, 1998.

Amend subrule 98.24(1), paragraph "c," subparagraph (1), as follows:

(1) The obligor's gross yearly income shall be divided by 200 percent of the established yearly gross poverty level income for one person. That amount shall be multiplied by .5. The resulting figure will be the percent of the current support order (rounded up to the nearest whole number) which shall be withheld for payment on the arrearage.

Further amend subrule 98.24(1), paragraph "c," by adding the following new subparagraph (3):

(3) If criteria for withholding 20 percent toward liquidation of any delinquency are also met, the lesser of 20 percent or hardship is to be withheld.

Amend subrule 98.24(2), introductory paragraph, as follows:

98.24(2) Current obligation ended. When the current support obligation has ended or has been suspended, the income withholding order shall remain in effect until any delinquency has been satisfied. The amount withheld shall be equal to the amount of the most recent prior current support obligation which is greater than zero. Hardship criteria shall be applied in accordance with subrule 98.24(1). However, in the following circumstances, the amount withheld shall be 50 20 percent of the amount owed for current support at the time the obligation ended or was suspended; and, if hardship criteria are met, this amount shall be one-half of the amount established under the guidelines in subrule 98.24(1):

Amend subrule 98.24(2), paragraph "d," as follows:

d. In a foster care case, the order for parental liabilityended when the child left placement, or an order ending the liability has been entered and the child in foster care has returned to the home of a parent ordered to pay parental liability. In this situation, the amount withheld shall be reduced to 50 20 percent of the current support amount when the obligation ended, but only for the parent with whom the child resides.

ITEM 2. Amend 441--Chapter 98, Division II, Part B, by adding the following new rule:

441--98.37(252D) Immediate income withholding amounts when current support has ended. When the child support obligation has ended, the amounts to be withheld shall be in accordance with subrule 98.24(2).

ITEM 3. Amend rule 441--98.45(252D) as follows:

Amend subrules 98.45(1) and 98.45(3) as follows:

98.45(1) Current support obligation changed. There has been a change in the amount of the current support obligation. Obligation changes due to emancipation are not grounds for modifying the amount withheld to apply to any delinquency from 50 to 20 percent.

98.45(3) Past due support paid. Any past due support debt has been paid in full. The withholding order shall be modified to require that only the current support obligation be withheld from the income of the obligor. Should a delinquency later accrue, the withholding order may again be modified to secure an additional payment toward the delinquency. The amount of the arrears payment shall be set according to rule 441--98.24(252D) at 20 percent of the current support amount.

Further amend rule 441--98.45(252D) by adding the following new subrules:

98.45(4) Income withholding order and determination of controlling orders. An obligation amount different than what CSRU has been enforcing is established upon the determination of controlling order as allowed in Iowa Code section 252K.207. Upon the change to the new obligation amount, the amount withheld to be applied toward the liquidation of any delinquency shall be 20 percent.

98.45(5) Income withholding order and review and adjustment of orders. If CSRU has initiated a review and adjustment of the obligation pursuant to 441--Chapter 99, Division IV, CSRU shall modify the amount withheld to be applied toward the liquidation of any delinquency to 20 percent upon completion of the process.

ARC 8105A

These amendments implement revisions to day care center policy involving unpaid volunteers and to the child day care home pilot program as mandated by the Seventy-seventh General Assembly in 1998 Iowa Acts, Senate File 2312.

Volunteers in child day care facilities who are included in the staff ratio count are mandatory reporters of child abuse. Current policy requires those volunteers to obtain certification showing completion of a minimum of two hours of Iowa's training for mandatory reporting of child abuse within six months from the initial date the person served as a volunteer or substitute. Persons who volunteer or substitute two times or less in a calendar year are exempt from the two-hour training requirement and shall sign a statement indicating they have been informed of their responsibilities as a mandatory reporter.

1998 Iowa Acts, Senate File 2312, requires that a person who serves as an unpaid volunteer in a child day care facility shall not be required to complete training as a mandatory reporter. These amendments remove the certification requirement but continue to require volunteers who are included in the staff ratio to sign a statement indicating they have been informed of their responsibilities as a mandatory reporter.

The child day care home pilot program is a four-level system of registration for family or group day care homes operating in Delaware and Scott counties. The revisions to the pilot program are as follows:

* Qualified providers may be registered at level II, III, or IV even though the amount of space required to be available for the maximum number of children authorized for that level exceeds the actual amount of space available in that child care home. The total number of children authorized for the child care home at that level of registration shall be limited by the amount of space available per child. The basic number of children permitted for each age group may not be exceeded.

* The number of children who can be in the home before a second person must be present who meets the individual qualifications for child care home registration is increased from seven to eight.

* A transition period from April 20, 1998, through April 19, 2000, is allowed for providers seeking to become registered in the pilot project for the first time. The number of infants and school-age children allowed to be in care at one time is lower for the pilot project than for the statewide program. The transition period will permit providers in the pilot project area to allow the numbers of infants and school-age children to drop from the program through natural attrition rather than having to drop children immediately to become registered.

The Department of Human Services finds that notice and public participation are unnecessary and impracticable because these amendments merely conform rules to state law which was effective upon enactment April 20, 1998. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these amendments confer a benefit on the public and on providers in the pilot project area by providing a transition period and allowing providers to become registered without dropping children from the program. Persons serving as unpaid volunteers in child day care facilities will not have to take unnecessary training. Implementation of these amendments eliminates the possibility of confusion on the public's part due to discrepancies between rules and statute. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)"b"(2).

These amendments are also published herein under Notice of Intended Action as ARC 8104A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code Supplement chapter 237A and 1998 Iowa Acts, Senate File 2312, sections 1 to 4.

These amendments became effective June 10, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 109.6(5), paragraph "b," subparagraph (3), as follows:

(3) Obtain certification showing completion of a minimum of two hours of Iowa's training for mandatory reporting of child abuse within six months from the initial date the person served as a volunteer or substitute. Persons who volunteer or substitute two times or less in a calendar year shall be exempt from the two-hour training requirement and shall sign Sign a statement indicating they have the volunteer or substitute has been informed of their the volunteer's or substitute's responsibilities as a mandatory reporter.

ITEM 2. Amend rule 441--110.27(237A) as follows:

Amend subrule 110.27(4), paragraph "a," subparagraph (1), as follows:

(1) Except as otherwise provided in this paragraph, not more than 12 children shall be present at any one time. If more than 7 8 children are present, a second person must be present who meets the individual qualifications for child care home registration.

Adopt the following new subrule 110.27(5):

110.27(5) Exception to total numbers. A child day care home may be registered at level II, III, or IV if the provider is qualified even though the amount of space required to be available for the maximum number of children authorized for that level exceeds the actual amount of space available in that child care home. The total number of children authorized for the child care home at that level of registration shall be limited by the amount of space available per child. The basic number of children permitted for each age group may not be exceeded.

ITEM 3. Amend 441--Chapter 110 by adopting the following new rule 441--110.35(237A):

441--110.35(237A) Transition exception. The exception provisions of this rule are applicable to child care homes registering under Iowa Code Supplement 237A.3A during a transition period beginning April 20, 1998, and ending April 19, 2000. During the transition period, the following provisions shall apply, notwithstanding the previous specific rules:

110.35(1) Infant care. A child care home provider who is providing child day care to four infants at the time of registration in the pilot project at level I, II, or III may continue to provide care to those four infants. However, when the child care home no longer provides care to one or more of the infants or one or more of the infants reaches the age of 24 months, the transition period exception authorized in this rule shall no longer apply. The overall limitation on the number of children authorized for the level of care remains applicable.

110.35(2) Care of school-age children. A child care home provider who at the time of registration in the pilot project at level I, II, or III is providing child day care to school-age children in excess of the number of school-age children authorized for the registration level may continue to provide care for those children. The child care home provider may exceed the total number of children authorized for the level of registration by the number of school-age children in excess of the number authorized for the registration level. This transition period exception is subject to all of the following:

a. The provider must comply with the other requirements as to the number of children which is applicable to that registration level.

b. The maximum number of children attributable to the authorization for school-age children at the applicable registration level is five.

c. If more than eight children are present at any one time, the provider shall be assisted by a responsible person who is at least 14 years of age.

d. If the child care home no longer provides care to an individual school-age child who was receiving care at the time of the registration, the excess number of children allowed under the transition period exception shall be reduced accordingly.

ITEM 4. Amend the implementation clause following 441--Chapter 110 as follows:

These rules are intended to implement Iowa Code Supplement chapter 237A as amended by 1997 Iowa Acts, Senate File 541 1998 Iowa Acts, Senate File 2312.

ARC 8103A

These amendments raise financial eligibility for child day care services from 125 to 140 percent of the federal poverty guidelines except as set forth below and update income guidelines and the fees parents pay for child day care services based on their monthly gross income to be consistent with the federal poverty guidelines for 1998.

The financial eligibility for families with children with special needs is increased from 155 to 175 percent of the federal poverty level. The financial eligibility for families who have received Transitional Child Care for 24 consecutive months is established at 155 percent of the federal poverty level. Children requiring protective child day care are eligible without regard to income.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2410, section 12, subsection 3, and section 80, which authorizes the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of these amendments should be waived and these amendments be made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2410, section 80.

These amendments are also published herein under Notice of Intended Action as ARC 8102A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code section 234.6 and 1998 Iowa Acts, Senate File 2410, section 12, subsection 3.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 130.3(1), paragraph "d," subparagraph (2), as follows:

(2) Income eligible status. The monthly gross income according to family size is no more than the following amounts:

Family Size	For Child Day Care Monthly Gross Income							All Other Services Monthly Gross Income Below
	A		B		C		D
1 Member	$ 658	$ 671	$ 822	$ 939	$1,019	$1,040	$1,175	$ 583
2 Members	884	904	1,105	1,266	1,370	1,401	1,582	762
3 Members	1,111	1,138	1,389	1,593	1,722	1,763	1,991	942
4 Members	1,338	1,371	1,672	1,919	2,073	2,125	2,399	1,121
5 Members	1,564	1,604	1,955	2,246	2,424	2,486	2,808	1,299
6 Members	1,791	1,838	2,239	2,573	2,776	2,848	3,216	1,478
7 Members	2,018	2,071	2,522	2,899	3,127	3,210	3,624	1,510
8 Members	2,244	2,304	2,805	3,226	3,478	3,571	4,032	1,546
9 Members	2,471	2,538	3,089	3,553	3,830	3,933	4,122	1,581
10 Members	2,698	2,771	3,372	3,879	4,181	4,295	4,212	1,612

For child day care, Columns Column A and B, add $227 $233 for each additional person over 10 members. For child day care, Column B, add $327 for each additional person over 10 members. For child day care, Column C, add $101 $362 for each additional person over 10 members. For child day care, Column D, add $90 for each additional person over 10 members. For other services, add $33 for each additional person over 10 members.

Column A is used to determine income eligibility when funds are insufficient to serve additional families beyond those already receiving services or requiring protective child day care and applications are being taken from (1) families who are at or below 100 percent of the federal poverty guidelines and in which the parents are employed at least 30 hours per week or are under the age of 21 and participating in an educational program leading to a high school diploma or equivalent, from (2) parents under the age of 21 with a family income at or below 100 percent of the federal poverty guidelines who are participating, at a satisfactory level, in an approved training or education program, and from (3) families who are at or below 100 percent of the federal poverty guidelines and are employed part-time at least 20 hours per week. (See 441--paragraphs 170.2(4)"a," "c," and "g.")

Column B is used to determine income eligibility when funds are insufficient to serve additional families beyond those already receiving services or requiring protective child day care and applications are being taken from families with an income of more than 100 percent but not more than 125 140 percent of the federal poverty level whose members are employed at least 30 hours per week (see 441--paragraph 170.2(4)"d") or when there is adequate funding and no waiting lists and applications are being taken from families applying for services, with the exception of families with children with special needs.

Column C is used to determine income eligibility for families with children with special needs and for families who have received transitional child care for 24 consecutive months.

Column D is used to determine income eligibility for families with children with special needs.

ITEM 2. Amend subrule 130.4(3), "Monthly Income Increment Levels According to Family Size" table, as follows:

Monthly Income Increment Levels According to Family Size
Income Increment Levels	1	2	3	4	5	6	7	8	9	10	Half-Day Fee
A	626 638	841 860	1056 1082	1272 1303	1487 1525	1702 1747	1918 1968	2133 2190	2348 2412	2564 2633	.00
B	659 672	885 905	1112 1139	1339 1372	1565 1605	1792 1839	2019 2072	2245 2305	2472 2539	2699 2772	.50
C	696 710	935 956	1174 1203	1414 1449	1653 1695	1892 1942	2132 2188	2371 2434	2610 2681	2850 2927	1.00
D	735 749	987 1009	1240 1270	1493 1530	1745 1790	1998 2051	2251 2311	2503 2570	2757 2831	3010 3091	1.50
E	776 791	1042 1066	1309 1341	1577 1616	1843 1890	2110 2166	2378 2440	2644 2714	2911 2990	3178 3264	2.00
F	819 836	1101 1125	1383 1416	1665 1706	1946 1996	2228 2287	2511 2577	2792 2866	3074 3157	3356 3447	2.50
G	865 882	1162 1188	1460 1496	1758 1802	2055 2108	2353 2415	2651 2721	2948 3027	3246 3334	3544 3640	3.00
H	914 932	1227 1255	1542 1579	1857 1903	2170 2226	2485 2550	2800 2873	3113 3196	3428 3521	3743 3844	3.50
I	965 984	1296 1325	1628 1668	1961 2009	2292 2350	2624 2693	2957 3034	3287 3375	3620 3718	3952 4059	4.00
J	1019 1039	1369 1399	1720 1761	2071 2122	2420 2482	2771 2844	3122 3204	3472 3564	3823 3926	4174 4287	4.50
K	1076 1097	1445 1478	1816 1860	2187 2240	2556 2621	2926 3003	3297 3383	3666 3764	4037 4146	4407 4527	5.00
L	1136 1159	1526 1561	1918 1964	2309 2366	2699 2768	3090 3171	3482 3573	3871 3975	4263 4378	4654 4780	5.50
M	1200 1224	1612 1648	2025 2074	2438 2498	2850 2923	3363 3349	3677 3773	4088 4197	4501 4623	4915 5048	6.00

ARC 8101A

These amendments implement revisions in purchase of service reimbursement rates mandated by the Seventy-seventh General Assembly. These revisions increase the maximum daily reimbursement rate for shelter care from $76.61 to $78.14; the maximum reimbursement rate for adoption and independent living services by 2 percent over the rates in effect on June 30, 1998; and the rates for adult residential, sheltered work, and work activity by 3 percent over the rates in effect on June 30, 1998.

Purchase of service rates have been frozen by the legislature since 1991 except for adult residential rates which were increased in state fiscal year 1996 and sheltered work and work activity rates which were increased in 1997. Counties which rely on the Department to establish rates for providers of adult residential, sheltered work, and work activity services will experience increased costs.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2410, section 32, subsections 5, 8, and 14, and section 80, which authorizes the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of these amendments should be waived and these amendments be made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2410, section 80.

These amendments are also published herein under Notice of Intended Action as ARC 8100A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code section 234.6 and 1998 Iowa Acts, Senate File 2410, section 32, subsections 5 and 8.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 150.3(5), paragraph "p," as follows:

Amend subparagraph (1) as follows:

(1) Unless otherwise provided for in 441--Chapter 156, rates for shelter care shall not exceed $76.61 $78.14 per day based on a 365-day year.

Amend subparagraph (2), introductory paragraph, and numbered paragraph "1," first paragraph, as follows:

(2) For the fiscal year beginning July 1, 1997 1998, the maximum reimbursement rates for services provided under a purchase of social service agency contract (adoption; local purchase services including adult day care, adult support, adult residential, community supervised apartment living arrangement, sheltered work, work activity, and transportation; shelter care; family planning; and independent living) shall be the same as the rates in effect on June 30, 1997 1998, except under any of the following circumstances:

1. If a new service was added after June 30, 1997 1998, the initial reimbursement rate for the service shall be based upon actual and allowable costs. A new service does not include a new building or location or other changes in method of service delivery for a service currently provided under the contract.

Renumber subparagraphs (3) and (4) as numbered paragraphs "3" and "4," respectively, under subparagraph (2).

Further amend subparagraph (2), renumbered paragraphs "3" and "4," as follows:

3. For the fiscal year beginning July 1, 1997 1998, the combined service and maintenance reimbursement rate paid to a shelter care provider shall be based on the financial and statistical report submitted to the department. The maximum reimbursement rate shall be $76.61 $78.14 per day. If the department reimburses the provider at less than the maximum rate, but the provider's cost report justifies a rate of at least $76.61 $78.14, the department shall readjust the provider's reimbursement rate to the actual and allowable cost plus the inflation factor or $76.61 $78.14, whichever is less.

4. For the fiscal year beginning July 1, 1997 1998, the purchase of service reimbursement rate for adult residential, sheltered workshops, and work activity services shall be increased by 1 3 percent of the reimbursement rate in effect on June 30, 1997 1998.

Further amend subparagraph (2) by adding the following new numbered paragraph "5":

5. For the fiscal year beginning July 1, 1998, the purchase of service reimbursement rate for adoption and independent living services shall be increased by 2 percent of the rates in effect on June 30, 1998.

ITEM 2. Amend subrule 150.22(7), paragraph "p," as follows:

Amend subparagraph (1), introductory paragraph, and numbered paragraph "1," first paragraph, as follows:

(1) For the fiscal year beginning July 1, 1997 1998, the maximum reimbursement rates for local purchase services, including adult day care, adult support, adult residential, community supervised apartment living arrangement, sheltered work, work activity, and transportation shall be the same as the rates in effect on June 30, 1997 1998, except under any of the following circumstances:

1. If a new service was added after June 30, 1997 1998, the initial reimbursement rate for the service shall be based upon actual and allowable costs. A new service does not include a new building or location or other changes in method of service delivery for a service currently provided under the contract.

Amend subparagraph (2) as follows:

(2) For the fiscal year beginning July 1, 1997 1998, the purchase of service reimbursement rate for adult residential, sheltered work, and work activity services shall be increased by 1 3 percent of the reimbursement rate in effect on June 30, 1997 1998.

ARC 8099A

These amendments implement the following changes mandated by the Seventy-seventh General Assembly:

1. The maximum foster family basic monthly maintenance rate and the maximum adoption subsidy rate for children remain at 70 percent of the United States Department of Agriculture's estimate of the cost to raise a child in the Midwest with a cost-of-living increase added for Fiscal Year 1999.

The daily foster family care and adoption payment rates are increased as follows: for a child aged 0 through 5 from $13.01 to $13.45, for a child aged 6 through 11 from $13.77 to $14.25, for a child aged 12 through 15 from $15.48 to $15.96, and for a child aged 16 and over from $15.47 to $15.96.

2. The regional budget target for children in group care is revised to reflect the new appropriation amount of $30,923,872 and the amount of $1,392,457 to be targeted to provision of 50 highly structured juvenile program beds.

3. The formula for allocating a portion of the statewide budget target for group care services to each of the Department's regions is revised to adjust one factor used in the formula.

4. Responsibility for working with the Department to ensure that a region's group care expenditures shall not exceed allocated funds is changed from the court to juvenile court services.

5. A provision is added to require the Department and juvenile court services to review all group care placements in a region to identify those which might be appropriate for termination if annualization of the region's expenditures for group care indicates the region will exceed its allocated amount for group care by more than 5 percent.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation regarding the foster care and adoption rate increase are unnecessary because these amendments implement 1998 Iowa Acts, Senate File 2410, section 32, subsection 4, which authorizes the Department to adopt rules without notice and public participation.

The Department also finds, pursuant to Iowa Code section 17A.5(2)"b"(1), that the normal effective date of the amendments regarding the foster care and adoption rate increase should be waived and these amendments be made effective July 1, 1998, as authorized by 1998 Iowa Acts, Senate File 2410, section 32, subsection 14, and section 80.

The Department of Human Services finds that notice and public participation on the amendments regarding the group care expenditure target are unnecessary because the expenditure target has been set by the General Assembly in 1998 Iowa Acts, Senate File 2410, section 15, subsection 2, paragraphs "a," "b," "d," and "e," and notice and public participation on the amendment containing the regional allocation formula is impracticable because there is not time to allow for comment on the allocation formula and still allocate the funding to the regions by July 1, 1998, to allow the representatives appointed by the Department and juvenile court services to establish their plan to contain expenditures. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that the amendments regarding the group expenditure target and regional allocation formula confer a benefit by eliminating confusion on the part of the public by conforming policy to Iowa Code language and by allowing for timely planning for containing expenditures. Therefore, these amendments are filed pursuant to Iowa Code section 17A.5(2)"b"(2).

These amendments are also published herein under Notice of Intended Action as ARC 8098A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code section 234.6 and 1998 Iowa Acts, Senate File 2410, section 15, subsection 2, paragraphs "a," "b," "d," and "e," and section 32, subsection 4.

These amendments became effective July 1, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 441--156.6(234) as follows:

Amend subrule 156.6(1) as follows:

156.6(1) Basic rate. A monthly payment for care in a foster family home licensed in Iowa shall be made to the foster family based on the following schedule:

Age of child	Daily rate
0 through 5	$13.01 $13.45
6 through 11	13.77 14.25
12 through 15	15.48 15.96
16 and over	15.47 15.96

Further amend rule 441--156.6(234), implementation sentence, to read as follows:

This rule is intended to implement Iowa Code section 234.38 and 1997 Iowa Acts, House File 715, section 28, subsection 4 1998 Iowa Acts, Senate File 2410, section 32, subsection 4.

ITEM 2. Amend 441--Chapter 201, implementation sentence, to read as follows:

These rules are intended to implement Iowa Code sections 600.17 to 600.21 and 600.23; and 1997 Iowa Acts, House File 715, section 28, subsection 4 1998 Iowa Acts, Senate File 2410, section 32, subsection 4.

ITEM 3. Amend rule 441--202.17(232) as follows:

Amend subrule 202.17(1), paragraphs "a" and "b," as follows:

a. The fiscal year 1998 1999 state appropriation maximum for group care is $29,153,146 $30,923,872. $1,419,005 $1,392,457 of the appropriation is allocated as the state matching funding for 50 highly structured juvenile program beds. If the 50 beds provided for in this paragraph are not used, the remaining funds allocated may be used for group care.

b. Each region's portion of the group care appropriation shall be based on the following formula: 70 percent of the regional appropriation shall be based on the region's portion of children aged 5 through 17, according to the 1995 Woods and Poole population estimates; 15 percent shall be based on the region's portion of the average monthly group care population, excluding unaccompanied refugee minors, for fiscal years 1993 to 1996 1997; 10 percent shall be based on the region's portion of children at risk due to urban density, according to the 1995 Woods and Poole population estimates of the number of children residing in areas with population in excess of 47,000; and 5 percent shall be based on the region's portion of child poverty, according to the number of persons eligible for Medicaid in 1994 and the number of children receiving subsidized meals in 1993 to 1994 in proportion to the region's total child population.

Further amend subrule 202.17(1), paragraph "d," first unnumbered paragraph, as follows:

The department and the courts juvenile court services shall work together to ensure that a region's group care expenditures shall not exceed the funds allocated to the region for group care in the fiscal year.

Further amend subrule 202.17(1) by adding the following new paragraph "e":

e. If at any time after September 30, 1998, annualization of a region's current expenditures indicates a region is at risk of exceeding its group foster care expenditure target under Iowa Code section 232.143 by more than 5 percent, the department and juvenile court services shall examine all group foster care placements in that region in order to identify those which might be appropriate for termination. In addition, any aftercare services believed to be needed for the children whose placements may be terminated shall be identified. The department and juvenile court services shall initiate action to set dispositional review hearings for the placements identified. In the dispositional review hearing, the juvenile court shall determine whether needed aftercare services are available and whether termination of the placement is in the best interest of the child and the community.

Amend subrule 202.17(2), introductory paragraph, as follows:

202.17(2) Regional plan for achieving target. For each of the departmental regions, representatives appointed by the department and the juvenile court services shall establish a plan for containing the expenditure for children placed in group care within the budget target allocated to that region. The plan shall include monthly targets and strategies for developing alternatives to group care placements.

Further amend rule 441--202.17(232), implementation sentence, to read as follows:

This rule is intended to implement Iowa Code section 232.143 and 1997 Iowa Acts, House File 715, section 12, subsection 2, paragraphs "a," "d," and "e." 1998 Iowa Acts, Senate File 2410, section 15, subsection 2, paragraphs "a," "b," "d," and "e."

ARC 8097A

These rules define and structure the Department of Human Services' child care funding for empowerment areas. Funds are provided to community empowerment areas receiving a school-ready children grant pursuant to 1998 Iowa Acts, Senate File 2406, to develop and improve local child care capacity to better enable low-income parents to obtain or retain employment. These rules establish conditions and procedures for the disbursement, use, and administration of funds. This grants program is administered by the Department in conjunction with the Iowa Empowerment Board.

Community empowerment areas are intended to enable local communities to improve, coordinate, and reduce duplication of effort for education, health, and human service programs with an initial emphasis on families with young children. Senate File 2406 sets forth the requirements and responsibilities of local community empowerment areas, including the establishment and duties of community empowerment area boards. Each county and school district in the state has the option of participating in a community empowerment area.

Senate File 2406 provides for the creation of a state Iowa Empowerment Board, its membership and functions, and rule-making authority for carrying out its functions. The Iowa Empowerment Board consists of 11 voting members, 8 citizens appointed by the Governor, subject to confirmation by the Senate, and the directors of the Departments of Education, Human Services, and Public Health. In addition, six legislators sit on the Board as nonvoting members.

1998 Iowa Acts, Senate File 2410, appropriates funding from the federal Temporary Assistance for Needy Families (TANF) Block Grant. The Department may transfer TANF funding into child care to be granted to eligible communities for implementing child care strategies. Senate File 2410 establishes minimum eligibility criteria for community empowerment areas seeking a grant; identifies eligible activities for using funds; and specifies maximum funding levels for community empowerment areas. To receive funding, an area must be approved as a community empowerment area by the Iowa Empowerment Board.

The General Assembly appropriated $3,800,000 to the Department of Human Services for funding of these grants. The maximum funding amount a community empowerment area is eligible to receive shall be determined by applying the area's percentage of the state's average monthly Family Investment Program population in the preceding fiscal year to the total amount appropriated for the grant program. If the community empowerment board's request for funding is received by the Iowa Empowerment Board on or after August 1, 1998, the maximum funding amount shall be prorated for the fiscal year and rounded up to the nearest full month.

The Iowa Empowerment Board is responsible for developing criteria for determining which community empowerment areas shall receive funding and how much funding they shall receive and notifying the area board and the Department of their decision.

The Department of Human Services finds that notice and public participation are impracticable because of the immediate need for rules to implement the provisions of this program. Community empowerment area boards need to know the requirements for grant submittal as soon as possible to enable them to obtain the maximum grant available. According to 1998 Iowa Acts, Senate File 2410, section 2, applications for the grants must be received from the community empowerment boards by the Iowa Empowerment Board no later than July 31, 1998, to receive the maximum grant available. Grant proposals received on or after August 1, 1998, have the maximum funding amounts prorated and rounded up to the nearest full month. Therefore, these rules are filed pursuant to Iowa Code section 17A.4(2).

The Department finds that these rules confer a benefit on low-income parents of children from birth to five years of age by providing funding to enhance a community empowerment area's quality child care capacity to enable the parents to obtain or retain employment. Therefore, these rules are filed pursuant to Iowa Code section 17A.5(2)"b"(2).

These rules are also published herein under Notice of Intended Action as ARC 8096A to allow for public comment.

The Council on Human Services adopted these rules June 10, 1998.

These rules are intended to implement 1998 Iowa Acts, Senate File 2410, section 2.

These rules became effective June 10, 1998.

The following rules are adopted.

Adopt the following new chapter:

These rules define and structure the department of human services' child care funding for empowerment areas. Funds are provided to community empowerment areas receiving a school-ready children grant pursuant to 1998 Iowa Acts, Senate File 2406, to develop and improve local child care capacity to better enable low-income parents to obtain or retain employment. These rules establish conditions and procedures for the disbursement, use, and administration of these funds. This grants program is administered by the department in conjunction with the Iowa empowerment board, according to conditions set forth in 1998 Iowa Acts, Senate File 2410.

441--169.1(77GA,SF2410) Definitions.

"Applicant" means an entity seeking funding under these rules.

"Community empowerment area" or "area" means an entity as defined in 1998 Iowa Acts, Senate File 2406, and as further defined by any administrative rules implemented by the Iowa empowerment board pursuant to Senate File 2406.

"Department" means the department of human services.

"Iowa empowerment board" or "board" means the entity as defined in 1998 Iowa Acts, Senate File 2406.

"Low-income families" means families at or below 185 percent of the federal poverty level.

"Temporary Assistance for Needy Families (TANF)" means a federal funding stream, for which the state is eligible under Public Law 104-103, for use in welfare reform and related activities.

441--169.2(77GA,SF2410) Use of funds. Funds shall be used in compliance with federal law and shall be used only for enhancing quality child care capacity in support of parent capability to obtain or retain employment. The funds shall be used with a primary emphasis on low-income families with children from birth to age five.

169.2(1) Eligible activities. Funds shall be used to implement strategies identified by communities that may include, but are not limited to:

a. Developing capacity for regular child care, sick child care, night shift child care, and emergency child care.

b. Enhancing linkages between the Head Start program, the Early Head Start program, early childhood development programs, and child care assistance programs.

c. Implementing other strategies that enhance access to child care.

d. Supporting ongoing activities related to paragraphs "a" through "c."

169.2(2) Limitations on using funds. Funds shall not be used for any purposes precluded by federal law. The Iowa empowerment board may establish additional limitations on the use of funds.

169.2(3) Administrative costs. Community empowerment areas may use up to 5 percent of funding for administrative costs in administering the grant, provided those expenditures are directly related to the project. Administrative costs shall be as defined in 45 CFR 98.52 as amended to October 1, 1997.

441--169.3(77GA,SF2410) Eligibility for funding.

169.3(1) Eligible entities. Eligible entities are those designated as a community empowerment area by the Iowa empowerment board and approved by the board for a school-ready children grant.

169.3(2) Applications. The community empowerment area shall submit an application for funding to the Iowa empowerment board. Actions on the application will be made by the board based on criteria set forth by the board.

441--169.4(77GA,SF2410) Funding availability. The availability of funds is subject to the following parameters:

169.4(1) Total funding available. Total funding available in each state fiscal year shall be the amount set pursuant to enacted legislative appropriations, less any other obligations that the legislation creates. Funding shall be further subject to federal funding actions which reduce or eliminate the availability of this funding.

169.4(2) Administration of funds. These funds do not reside in the Iowa empowerment fund but are administered by the department. Upon the award of funding by the Iowa empowerment board, funds shall be disbursed to the community empowerment area by the department pursuant to a negotiated payment schedule that complies with state and federal law. Funds received by a community empowerment area shall be administered through a fiscal agent which is a public entity.

169.4(3) Obligated funds. Funds that have been applied for by and awarded to a community empowerment area prior to June 30 of each state fiscal year shall be considered obligated. These funds do not revert, but shall remain available to the area, regardless of whether the funding has yet been spent, if paid to the area by August 31 following the close of the state fiscal year in which the funds were obligated.

169.4(4) Unobligated funds. Funds that have not been obligated or paid pursuant to the preceding subrule shall revert and do not remain available to the area in a subsequent state fiscal year.

169.4(5) Eligible funding for area. In determining a community empowerment area's eligible funding, total funds available for the state fiscal year shall be prorated according to the following:

a. A community empowerment area's maximum eligible funding is the percentage of the total available funding which is equal to the area's percentage of average monthly statewide family investment program cases in the preceding state fiscal year, as reported to the Iowa empowerment board by the department.

b. The maximum eligible funding for a community empowerment area shall be prorated by the number of months remaining in the state fiscal year. If an area's application is approved by the Iowa empowerment board without revision, then the proration shall be from the date the application was received by the board. If the area's application required substantive revision, then the proration shall be from the date that the revised application which is approvable was received by the board. The board may fund the area retroactive to the original application receipt date if it determines that required revisions were not substantive. The month of the date of receipt as established herein shall be considered a full month.

c. The Iowa empowerment board may award a lesser amount than calculated pursuant to this subrule based on the nature of the community empowerment area's request.

441--169.5(77GA,SF2410) Community empowerment areas' responsibilities.

169.5(1) Fiscal agent. The community empowerment area shall designate a public agency as a fiscal agent and ensure that appropriate and adequate accounting mechanisms are in place through the fiscal agent to deposit, disburse and account for funds received, including tracking of the timing and purpose of any financial transaction.

169.5(2) Grant agreement. A grant agreement shall be entered into by the community empowerment area, the department, and the Iowa empowerment board.

169.5(3) Spending funds. The community empowerment area shall spend funds according to its application as approved by the Iowa empowerment board and grant agreement.

169.5(4) Reporting and audit requirements. The community empowerment area shall meet federal reporting and audit requirements. The Iowa empowerment board may establish other audit and reporting requirements.

441--169.6(77GA,SF2410) Iowa empowerment board's responsibilities.

169.6(1) Application review. The Iowa empowerment board shall review applications and act upon them in a timely manner.

169.6(2) Amount of funding. The Iowa empowerment board shall determine the amount of funding to be awarded, up to the eligible amount as defined in subrule 169.4(5).

169.6(3) Notification. The Iowa empowerment board shall notify the community empowerment area and the department of its decision.

169.6(4) Negotiating grant agreements. The Iowa empowerment board shall participate in negotiation of a grant agreement that includes:

a. The amount awarded.

b. How the funds will be used and the timing of disbursements from the department to the community empowerment area.

c. Expected results and reports on progress towards those results, including results for children from birth to age five.

d. An agreement by the community empowerment area to comply with federal reporting and audit requirements.

e. Other conditions mutually agreed to by the community empowerment area and the Iowa empowerment board.

169.6(5) Review. The Iowa empowerment board shall review the status and progress of grantees.

441--169.7(77GA,SF2410) Department of human services' responsibilities.

169.7(1) Disbursement of funds. The department shall disburse funds to community empowerment areas under grant agreements.

169.7(2) Technical assistance. The department shall, upon request of the board, provide technical assistance and other support to the Iowa empowerment board and community empowerment areas.

169.7(3) Negotiations and review. The department shall assist the Iowa empowerment board in negotiating grant agreements and, upon request, assist the Iowa empowerment board in reviewing the status and progress of grantees.

441--169.8(77GA,SF2410) Revocation of funding. Notwithstanding other portions of these rules, funding may be revoked under the following conditions.

169.8(1) Failure to comply.

a. Either the Iowa empowerment board or the department may revoke funds if the community empowerment area is failing to comply with federal reporting or audit requirements or is using funds for other than an allowable purpose. The revocation shall be prospective, and may also be retroactive if the failure to comply or use of funding is such that the federal funds already expended are in jeopardy of being recovered by the federal government.

b. The Iowa empowerment board may revoke funds if the community empowerment area is not complying with other conditions agreed to by the board and the area, or if the board determines that the area is not performing pursuant to their approved application or grant agreement or is not making satisfactory progress towards results. The revocation shall be prospective only and may include unexpended funds already obligated to the area.

169.8(2) Corrective action plan. Prior to notice of revocation, either the department or the Iowa empowerment board may first work with the community empowerment area to develop and implement a corrective action plan if in the discretion of the department or the Iowa empowerment board such a plan has a reasonable chance of success.

169.8(3) Subsequent application. A community empowerment area which has had its funding revoked may submit a subsequent application, which shall be considered a new application and eligible for prospective funding only. Applications submitted subsequent to a revocation of funding must also address how the matters leading to a previous revocation have been addressed in order to prevent problems from occurring again.

441--169.9(77GA,SF2410) Appeals. Applicants which are an approved community empowerment area with an approved school-ready children grant may file an appeal with the director of the department of human services as follows:

169.9(1) Appealable actions. Issues that can be appealed include disbursement of funds and revocation of funding if initiated by the department.

169.9(2) Nonappealable actions. The denial or rejection of a grant application, the amount of a grant award, and other actions taken by the Iowa empowerment board are not appealable to the director of the department of human services. These actions are subject to appeal procedures set forth by the Iowa empowerment board.

169.9(3) Letter of appeal. The letter of appeal must be submitted within five working days of the action of the department and must clearly and fully identify all issues being contested.

The director of the department shall review the appeal request and issue a decision within ten days of the request or within ten days of receipt by the department of any follow-up information requested from the appellant.

These rules are intended to implement 1998 Iowa Acts, Senate File 2410, section 2.

ARC 8127A

These amendments include the following:

1. Subrule 21.6(9) is amended by adopting new contribution rates for the special service groups covered under IPERS; by terminating protection occupation coverage of parole officer III and probation officer III classes as of June 30, 1998 (required by 1998 Iowa Acts, House File 2496); by striking references to previous contribution rates; and by changing the state tax treatment of employee contributions from posttax to pretax effective January 1, 1999 (also required by 1998 Iowa Acts, House File 2496).

2. Subrule 21.11(6) is amended to clarify IPERS' practices regarding the effective date when determining eligibility for retroactive payments.

3. Subrule 21.11(7) is amended to eliminate prorating the final month of benefits payable to a member who dies. The amendment provides that the entire final month is payable to the member and that monthly benefits payable to beneficiaries begin with the next month.

4. Subrule 21.11(9), fourth unnumbered paragraph, is amended to clarify that a member may be elected to a public office, retire from a different covered position, and assume the public office during the four-month period following retirement without violating the system's bona fide retirement rules.

5. New subrule 21.24(9) is adopted in order for IPERS to comply with federal legal requirements relating to the purchase of additional service credit.

In compliance with Iowa Code section 17A.4(2), the Department finds that notice and public participation are impracticable, contrary to public interest, and that these rules should be implemented immediately because the amendments revise IPERS' current interpretations and applications of its governing rules in a manner which is beneficial to members, or are required by statute. Specifically, the amendments: (1) adopt new contribution rates for special service groups as determined by IPERS' actuary; (2) remove parole and probation officer IIIs from the protection occupation class, as a result of legislation requested by those same groups; (3) implement legislation making employee contributions pretax for state income tax purposes; (4) permit members who die before the end of a month to retain the entire amount of the monthly benefit payable for the month in which death occurs, which should reduce overpayment claims by IPERS; (5) clarify how to determine eligibility for retroactive benefits payable to members based on their documented IPERS contacts and IPERS' subsequent production of benefit forms; (6) clarify that a member may be elected to public office, retire from a different covered position, and assume the elective position during the four-month period immediately following retirement without violating IPERS' bona fide retirement rules; and (7) ensure that service purchases do not cause IPERS to pay benefits in excess of the amount permitted under Internal Revenue Code Section 415.

The Department finds, pursuant to Iowa Code section 17A.5(2)"b"(2), that the normal effective date of the amendments should be waived and the amendments be made effective upon filing with the Administrative Rules Coordinator on June 11, 1998, because they confer benefits and remove restrictions on employees, or are required by statute, and will give employers and employees adequate notice of changes.

The Iowa Department of Personnel adopted these amendments on June 11, 1998.

These amendments are also published herein under Notice of Intended Action as ARC 8126A to allow public comment.

These amendments became effective June 11, 1998.

These amendments are intended to implement Iowa Code chapter 97B.

ITEM 1. Amend subrule 21.6(9) as follows:

21.6(9) Contribution rates. The following contribution rate schedule, payable on the covered wage of the member, is determined by the position or classification and the occupation class code of the member.

a. No change.

b. Sheriffs, deputy sheriffs, and airport firefighters, effective July 1, 1997 1998.

(1) Member's rate--5.91 6.34%.

(2) Employer's rate--8.87 9.51%.

c. Members employed in a protection occupation, effective July 1, 1997 1998.

(1) Member's rate--5.64 5.61%.

(2) Employer's rate--8.45 8.41%.

d. Members employed in a "protection occupation" shall include:

(1) to (8) No change.

(9) Effective July 1, 1994, through June 30, 1998, a parole officer III with a judicial district of the department of correctional services.

(10) Effective July 1, 1994, through June 30, 1998, a pro-bation officer III with a judicial district of the department of correctional services.

e. Prior special rates are as follows:

(1) Effective July 1, 1992, through June 30, 1993:

1. Sheriffs and deputy sheriffs--member's rate-- 6.90%; employer's rate--10.34%.

2. Protection occupation--member's rate--5.88%; employer's rate-- 8.83%.

(2) Effective July 1, 1993, through June 30, 1994:

1. Sheriffs and deputy sheriffs--member's rate-- 6.92%; employer's rate--10.39%.

2. Protection occupation--member's rate--5.94%; employer's rate--8.91%.

(3) Effective July 1, 1994, through June 30, 1995:

1. Sheriffs, deputy sheriffs, and airport firefighters--member's rate--7.05%; employer's rate--10.58%.

2. Protection occupation--member's rate--6.11%; employer's rate--9.17%.

(4) Effective July 1, 1995, through June 30, 1996:

1. Sheriffs, deputy sheriffs, and airport firefighters--member's rate--6.85%; employer's rate--10.27%.

2. Protection occupation--member's rate--6.01%; employer's rate--9.02%.

(5) Effective July 1, 1996, through June 30, 1997:

1. Sheriffs, deputy sheriffs, and airport firefighters--member's rate--6.76%; employer's rate--10.14%.

2. Protection occupation--member's rate--5.95%; employer's rate--8.92%.

Effective July 1, 1997, through June 30, 1998:

1. Sheriffs, deputy sheriffs, and airport firefighters--member's rate--5.91%; employer's rate--8.87%.

2. Protection occupation--member's rate--5.64%; employer's rate--8.45%.

f. Pretax.

(1) Effective January 1, 1995, employers must pay member contributions on a pretax basis for federal income tax purposes only. Such contributions are considered employer contributions for federal income tax purposes and employee contributions for all other purposes. Employers must reduce the member's salary reportable for federal income tax purposes by the amount of the member's contribution.

(2) Salaries reportable for purposes other than federal income tax will not be reduced, including IPERS, FICA, and, through December 31, 1998, state income tax purposes.

(3) Effective January 1, 1999, employers must pay member contributions on a pretax basis as provided in subparagraph (1) above for both federal and state income tax purposes.

ITEM 2. Amend subrule 21.11(6), introductory paragraph, as follows:

21.11(6) A member retiring on or after the early retirement or normal retirement date shall submit a written notice to IPERS setting forth the retirement date, provided the date is after the member's last day of service and not before the first day of the sixth calendar month preceding the month in which the notice is filed. A member's first month of entitlement shall be no earlier than the first day of the first month after the member's last day of service, or if later, the month provided for under subrule 21.18(2). A member who does not begin benefits timely in the first month that begins after the member's last day of service may receive up to six months of retroactive payments. The period for which retroactive payments may be paid is measured from the month that a valid contact occurs. For purposes of this subrule, a "contact" means a telephone call, facsimile transmission, E-mail, visit to IPERS at its offices or off-site locations, or a letter or other writing requesting a benefits estimate or application to retire, whichever is received first. A contact is only valid if a completed application to retire is received within six months following the month that a benefits estimate or application to retire form is mailed to the member in response to the contact. If a completed application to retire form is received more than six months after such a benefits estimate or application to retire is mailed, retroactive payments may only be made for up to six months preceding the month that the completed application to retire is received.

ITEM 3. Amend subrule 21.11(7) as follows:

21.11(7) Retirement benefits to a member shall terminate the day on which the member's death occurs. The benefits for the month of the member's death shall be prorated based on the number of days the member lived during that month. Notwithstanding the foregoing, for each death occurring on or after July 1, 1998, a member's retirement benefits shall terminate after payment is made to the member for the entire month during which the member's death occurs. For such deaths, death benefits shall begin with the month following the month in which the member's death occurs.

ITEM 4. Amend subrule 21.11(9), third unnumbered paragraph, as follows:

The bona fide retirement period will be waived, however, if the member terminates regular employment, begins benefits, and is then is elected to public office which term begins during the normal four-month bona fide retirement period. This waiver does not apply if the member was an elected official who was reelected to the same position for another term.

ITEM 5. Adopt a new subrule 21.24(9) as follows:

21.24(9) IRC Section 415(n) compliance. Effective for service purchases made on or after January 1, 1998, service purchases made under this rule and other posttax contributions shall not exceed $30,000 per calendar year. In addition, the amounts contributed for service purchases under this rule shall not exceed the amount required to purchase the service according to the current cost schedules. In implementing these and the other requirements of IRC Section 415(n),IPERS shall use the following procedures.

a. If the member's total benefit at retirement passes the fully reduced IRC Section 415(b) dollar limit test, IPERS shall pay the total benefit.

b. If the member's total benefit at retirement fails the fully reduced IRC Section 415(b) dollar limit test, and the member made one or more service purchases, IPERS shall perform the applicable IRC Section 415 tests, with adjustments for posttax service purchases and other posttax contributions, and pay excess amounts, if any, under a qualified benefits arrangement authorized under Iowa Code section 97B.49I.

c. IPERS shall not permit the purchase of nonqualified service, as defined under IRC Section 415(n), unless such service is specifically authorized by the Iowa legislature. If so authorized, a member must have five years of existing service to make such a purchase, and the quarters of service purchased cannot exceed 20.

d. The limitations of this rule shall not apply to buybacks of prior refunds. In addition, the $30,000 annual limit under this rule shall not apply to service purchases grandfathered under the provisions of the Iowa Code and Section 1526 of the Taxpayer Relief Act of 1997.

e. If IPERS adopts rules and procedures permitting service to be purchased on a pretax basis, the amounts contributed will not be combined with posttax service purchases and other posttax contributions in applying the foregoing procedures.

f. The provisions of this subrule shall apply to all vested members who have an account balance, and retirees.

g. IPERS reserves the right to apply the limitations of IRC Section 415(n) on a case-by-case basis to ensure that such limits are not exceeded.

This rule is intended to prohibit honeybees from being transported into Iowa from the state of Florida because it is known to be infested with Varroa mites that are resistant to fluvalinate miticide, the only product registered for the control of Varroa mites.

Notice of Intended Action was published in the Iowa Administrative Bulletin May 6, 1998, as ARC 7979A. All comments received were in support of the proposed rule. This rule is identical to that published under Notice of Intended Action. This rule was simultaneously Adopted and Filed Emergency and published in the May 6, 1998, Iowa Administrative Bulletin as ARC 7980A.

This rule is intended to implement Iowa Code section 160.9.

This rule shall become effective on August 5, 1998, at which time the Adopted and Filed Emergency rule is hereby rescinded.

The following rule is adopted.

Amend 21--Chapter 22 by adopting the following new rule.

21--22.10(160) Prohibit movement of infested bees. A person shall not directly or indirectly transport or cause to be transported into the state of Iowa honeybees originating inthe state of Florida.

ARC 8123A

The Seventy-seventh General Assembly in 1998 Iowa Acts, Senate File 2410, directed the Department to develop a new rehabilitative treatment and supportive services authorization model, including a toll-free telephone number for preauthorization on or before November 1, 1998. Notwithstanding 1997 Iowa Acts, chapter 208, section 12, subsection 18, which required the Department to eliminate the current Clinical Assessment and Consultation Teams (CACT), the Department was given authority to extend the existence of the current CACT until October 31, 1998.

The legislation further required that the new model be developed and implemented in a manner so as to streamline the authorization process, to reduce paperwork and other information requirements to the minimum level necessary for compliance with federal requirements, and to ensure timely response to authorization requests.

These amendments revise the authorization process for Rehabilitative Treatment and Supportive Services as follows. In addition, various incorrect rule references are updated for clarity.

* The Clinical Assessment and Consultation Teams are replaced by a "review organization" which is designated by the Department to complete service authorizations. The Department has designated the Iowa Foundation for Medical Care (IFMC) as its review organization at this time. Effective August 15, 1998, IFMC will begin taking requests for authorization from some referral workers. Transition to the new authorization process will be completed statewide by November 1, 1998.

* The new authorization process requires the referral worker to telephone the review organization and relay oral information instead of transferring the needed information in documents. The review organization is required to provide an immediate decision at the time of the telephone contact by the referral worker. If additional information is required for the authorization, the review organization is required toprocess the authorization within one day of receipt of the additional information requested from the referral worker.

* Specific criteria for eligibility and authorization denials have been added to be consistent with the minimum federal requirements and provide specific information about the basis of approval or denial by the review organization. The review organization is required to maintain documentation at the minimum level necessary for compliance with federal requirements.

* After-hours authorization by the review organization is eliminated and supervisory approval prior to initiating family preservation is required when there is imminent risk of placement or an emergency protective need. The referral worker must then contact the review organization for approval on the next business day.

* The appeal process is changed to include reconsideration by the review organization prior to filing an appeal.

In compliance with Iowa Code section 17A.4(2), the Department of Human Services finds that notice and public participation regarding changes in the authorization process are unnecessary and impracticable because these amendments implement 1998 Iowa Acts, Senate File 2410, section 15, subsection 18, and section 80, which authorizes the Department to adopt rules without notice and public participation.

Notice and public participation regarding changing of the rule references are unnecessary because the change merely corrects the references and has no effect on policy or procedure. Therefore, these amendments are filed pursuant to Iowa Code section 17A.4(2).

These amendments are also published herein under Notice of Intended Action as ARC 8122A to allow for public comment.

The Council on Human Services adopted these amendments June 10, 1998.

These amendments are intended to implement Iowa Code sections 234.6, 234.38, and 249A.4 and 1998 Iowa Acts, Senate File 2410, section 15, subsection 18.

These amendments shall become effective August 15, 1998.

The following amendments are adopted.

ITEM 1. Amend rule 441--7.1(217), definition of "Aggrieved person," last paragraph of numbered item "8," as follows:

A person who has requested a specific rehabilitative treatment service as defined in rule 441--185.1(234) may be an aggrieved person if the referral entity worker does not make a referral to the clinical assessment and consultation team (CACT) review organization for the services requested or if the person is dissatisfied with the necessity, amount, duration, or scope of services as authorized by the CACT review organization. Providers and referral entities workers who are dissatisfied with the amount, duration or scope of rehabilitative treatment services authorized shall not be considered an aggrieved person.

ITEM 2. Amend rule 441--78.42(249A) as follows:

441--78.42(249A) Rehabilitative treatment services. Payment will be made for rehabilitative treatment services as described in 441--Chapter 185, Divisions II to V, when the rehabilitative treatment services have been authorized by the clinical assessment team (CACT) review organization under the provisions set forth in rules 441--185.5(234) rule 441-- 185.4(234) and 441--185.6(234) and when the services are provided by providers certified as described in rules 441-- 185.9(234) to 441--185.10(234) and 441--185.11(234).

ITEM 3. Amend rule 441--130.1(234) as follows:

Rescind the definition of "Clinical assessment and consultation team (CACT)."

Add the following new definition in alphabetical order:

"Review organization" means the entity designated by the department to make rehabilitative treatment service authorization determination.

ITEM 4. Amend subrule 130.2(8) as follows:

130.2(8) For rehabilitative treatment services, the worker shall make a referral of the child or family to a clinical assessment and consultation team (CACT) the review organization as directed in rule 441--185.3(234).

ITEM 5. Amend subrule 130.6(1) as follows:

130.6(1) Determine eligibility. For rehabilitative treatment services, eligibility shall be determined by the clinical assessment and consultation team (CACT) review organization as directed in 441--subrule 185.2(2).

ITEM 6. Amend rule 441--133.1(235), definition of "Family preservation services," as follows:

"Family preservation services" includes treatment services and family assistance fund services received after CACT authorization of either family preservation-full program or family preservation-short term means treatment services and supportive services provided in the family preservation program that have duration limited to 60 calendar days, but are expected to last an average of 45 calendar days.

ITEM 7. Amend 441--Chapter 152, Preamble, first paragraph, as follows:

ITEM 8. Amend rule 441--152.1(234) as follows:

Amend the definitions of "Referral worker," "Rehabilitative treatment services," and "Service authorization" as follows:

"Referral worker" means the department worker or juvenile court officer who refers the case to the CACT revieworganization and who is responsible for carrying out thefollow-up activities after the CACT review organization service necessity determination and service authorization proc-ess is completed.

"Rehabilitative treatment services," for the purpose of this chapter, means services designed to address the rehabilitative treatment needs of a child in one of the following programs:

1. Family-centered program.

2. Family preservation program.

3. Family foster care.

4. Group care program.

"Service authorization" means the process of service necessity determination and service authorization of scope, amount and duration by the CACT review organization. There are two kinds of service authorization: regular and immediate.

Rescind the definition of "Clinical assessment and consultation team (CACT)."

Add the following new definitions in alphabetical order:

"Nonrehabilitative treatment services," for the purpose of this chapter, means rehabilitative services designed to address a child's nonrehabilitative treatment needs as defined in rule 441--185.1(234) in one of the following programs:

1. Family-centered program.

2. Family preservation program.

"Review organization" means the entity designated by the department to make rehabilitative treatment service authorization determination.

ITEM 9. Amend 441--Chapter 152, Division II, Preamble, as follows:

This division addresses how existing family-centered, family preservation, family foster care, and group care providers enter into new contracts to provide rehabilitative treatment and supportive services on or after November 1, 1993; describes how new family-centered, family preservation, family foster care, and group care providers enter into a contract to provide rehabilitative treatment services, nonrehabilitative treatment services, and supportive services on or after January 1, 1994; explains how contracts are administered by department project managers; presents the fiscal records standards; and sets forth the requirements for client eligibility and CACT review organization referral and authorization process as a condition of reimbursement.

ITEM 10. Amend subrules 152.24(1) and 152.24(2) as follows:

152.24(1) Determination of eligibility. For the department to make payment for rehabilitative treatment services, clients shall be determined eligible by the CACT review organization. Eligibility for nonrehabilitative treatment services shall be determined pursuant to 441--subrule 185.2(4). Eligibility for supportive services shall be determined by the referral worker pursuant to the rules established for the service. The department shall not make payment for rehabilitative treatment or supportive services provided prior to the client's eligibility determination.

152.24(2) Court order. If a child and family have been referred to CACT the review organization and the CACT review organization has not authorized rehabilitative treatment services, but the services have been ordered by the juvenile court, the referral worker shall refer the case back to the CACT review organization for reconsideration of eligibility in light of the juvenile court's determination. If the CACT review organization continues not to authorize the services ordered by the juvenile court, the department shall make payment subject to availability of authorized funds.

ITEM 11. Amend rule 441--152.25(234) as follows:

441--152.25(234) Amount, scope, and duration of services. Any change in the scope, or increase in the amount or duration of rehabilitative treatment services, shall be authorized by the CACT review organization.

ITEM 12. Amend subrule 156.6(4), paragraph "e," as follows:

e. When a human services area administrator determines that a foster family is providing care comparable to behavioral management services for children in therapeutic foster care pursuant to 441--subrule 185.62(3), except that the placement is supervised by the department and the child's treatment plan is supervised by a physician, mental health professional, or mental retardation professional, the foster family shall be paid the basic maintenance rate plus $14.80 per day. Foster families receiving this difficulty of care payment shall meet the requirements as found in 441--paragraph 185.10(8)"b." If the human services area administrator determines that a foster family has been providing this level of care prior to November 1, 1993, and the department has been paying the foster family difficulty of care payments in excess of $14.80 per day, the foster family shall continue to receive the higher payment for the duration of the time the human services area administrator determines that the foster family is providing care comparable to that provided to a child receiving behavioral management services for children in therapeutic foster care.

If the CACT review organization determines that the child has been receiving family foster care core three services prior to November 1, 1993, and if the foster family has been receiving difficulty of care payments in excess of $14.80 per day, the department shall continue to pay the foster family the higher payment for the duration of the time the CACT review organization authorizes family foster care core three services.

ITEM 13. Amend subrule 156.20(1), paragraph "a," subparagraph (2), as follows:

(2) Limitations. Department payment for group care shall be limited to placements which have been authorized by the clinical assessment and consultation team (CACT) review organization pursuant to rule 441--185.5(234) 441--185.4(234) and which conform to the regional group care plan developed pursuant to rule 441--202.17(232). Payment for an out-of-state group care placement shall be limited to placements approved pursuant to 441--subrule 202.8(2) and where the facility meets provider certification according to rule 441--185.9(234) or 441--185.10(234).

ITEM 14. Amend rule 441--181.1(234) as follows:

Rescind the definition of "Nonrehabilitative treatment service" and insert the following new definition in lieu thereof:

"Nonrehabilitative treatment service" means a service to address the nonrehabilitative treatment need of a child. Nonrehabilitative treatment services are designed either to restore a skill or function or teach a new skill or function to achieve maximum independence and functioning. These services may also be directed toward a family member to help them meet the treatment, safety, or permanency needs of a child. Nonrehabilitative treatment services are designed to meet treatment needs in one of the following programs:

1. Family-centered program.

2. Family preservation program.

Rescind the definition of "Clinical assessment and consultation team (CACT)."

Add the following new definitions in alphabetical order:

"Nonrehabilitative treatment need" means the child and family have a protective, supportive, or preventive need for which the child has no identified rehabilitative behavioral health treatment need. Services to address a nonrehabilitative treatment need may be directed at a family member to meet the child's safety, treatment, or permanency need.

"Review organization" means the entity designated by the department to make rehabilitative treatment service authorization determination.

ITEM 15. Amend rule 441--181.2(234) as follows:

441--181.2(234) Eligibility for family preservation supportive services. Families shall be eligible for family preservation supportive services when the department has determined there is a need for supportive services and family preservation treatment services have been authorized in compliance with the procedures of rule 441--181.4(234), 441--85.5(234) or 441--185.6(234) 441--185.4(234).

ITEM 16. Amend subrule 181.4(2), paragraphs "a" to "c," as follows:

a. A referral shall be made to CACT the review organization in accordance with the procedures in rule 441--185.6(234) 441--185.3(234), for determination of whether a rehabilitative behavioral health care treatment need exists. CACT shall make the determination within one hour of the initial contact by the referral worker in accordance with requirements in 441--subrule 185.6(4).

b. If CACT the review organization determines the child has a rehabilitative behavioral health care treatment need, family preservation services shall be authorized as outlined in 441--subrule 185.6(5) rule 441--185.4(234).

c. If CACT the review organization determines the child does not have a rehabilitative behavioral health care treatment need, the referral worker shall approve nonrehabilitative family preservation treatment services, assist the family in selecting an appropriate provider, arrange for services so that in emergency situations the provider has a face-to-face contact with the family in 3 hours and in all other situations within 24 hours, and notify the provider that the family preservation case is an immediate or emergency protective case. Once services have been arranged, the referral worker shall complete Form 470-3055, Referral of Client for Rehabilitative Treatment and Supportive Services, indicating service is approved with nonrehabilitative service treatment need for a duration not to exceed 60 days (actual service provided to average 45 days), and forward a copy to the provider and a copy to the department when the referral worker is with juvenile court.

ITEM 17. Amend rule 441--182.1(234) as follows:

Rescind the definition of "Nonrehabilitative treatment service" and insert the following new definition in lieu thereof:

"Nonrehabilitative treatment service" means a service to address the nonrehabilitative treatment need of a child. Nonrehabilitative treatment services are designed either to restore a skill or function or teach a new skill or function to achieve maximum independence and functioning. These services may also be directed toward a family member to help them meet the treatment, safety, or permanency needs of a child. Nonrehabilitative treatment services are designed to meet treatment needs in one of the following programs:

1. Family-centered program.

2. Family preservation program.

Rescind the definition of "Clinical assessment and consultation team (CACT)."

Add the following new definitions in alphabetical order:

"Authorization action" means an authorization determination approving rehabilitative treatment services.

"Nonrehabilitative treatment need" means the child and family have a protective, supportive, or preventive need for which the child has no identified rehabilitative behavioral health treatment need. Services to address a nonrehabilitative treatment need may be directed at a family member to meet the child's safety, treatment, or permanency need.

"Rehabilitative treatment need" means a medical-behavior health need of a child with a deficit in function or skill that the child lost or never gained as a result of interference in the normal maturational and learning process due to the child or parental dysfunction. The child must have the capability to benefit from the rehabilitative treatment services.

"Review organization" means the entity designated by the department to make rehabilitative treatment service authorization determination.

"Service authorization" means the process of service necessity determination and service authorization of scope, amount, and duration by the review organization.

ITEM 18. Amend rule 441--182.2(234) as follows:

Amend subrule 182.2(1), introductory paragraph, as follows:

182.2(1) Eligibility for supportive services. Children shall be eligible for family-centered supportive services without regard to income when the department worker has determined there is a need for services, as evidenced by one of the following situations, and family-centered rehabilitative treatment services have been authorized in compliance with the procedures of rule 441--185.5(234) 441-- 185.4(234), nonrehabilitative treatment services have been approved through procedures outlined in this chapter, or the department worker determines that comparable treatment services are being provided through another funding source. However, respite care services for families of MR/DD children, as defined in 441--Chapter 180, Division I, may be provided as a family-centered supportive service with or without provision of family-centered rehabilitative treatment or other treatment services.

Amend subrule 182.2(4), paragraphs "a" to "c," as follows:

a. A referral shall be made to CACT the review organization for service authorization in accordance with the procedures in rule 441--185.5(234) 441--185.3(234) for determination of whether a rehabilitative behavioral health care treatment need exists.

CACT The review organization will make the determination in accordance with the requirements of 441--subrule 185.5(4) rule 441--185.4(234).

b. If CACT the review organization determines that the child has a rehabilitative behavioral health care treatment need, family-centered services shall be authorized as outlined in rule 441--185.5(234) 441--185.4(234).

c. If CACT the review organization determines that the child does not have a rehabilitative behavioral health care treatment need for specific family-centered services and denies the request, the referral worker shall may, with supervisory approval, approve nonrehabilitative family-centered treatment services to address these the child's nonrehabilitative treatment needs, assist the family in selecting an appropriate provider, and notify the provider that the family-centered case was services are approved as on a nonrehabilitative treatment case basis. The referral worker shall not approve family-centered nonrehabilitative treatment services for a longer duration than the one requested in the referral denied by CACT. The referral worker shall complete Form 470-3055, Referral of Client for Rehabilitative Treatment and Supportive Services, indicating services are approved with nonrehabilitative service treatment need for a duration not to exceed 180 days six months, and forward a copy to the provider and a copy to the department when the referral worker is with juvenile court before services are provided to the child and family.

ITEM 19. Amend subrule 182.4(2) as follows:

182.4(2) Extensions. Nonrehabilitative treatment services may be extended if the referral worker again refers the case to CACT the review organization and CACT the review organization denies service because the child has no rehabilitative behavioral health care treatment need for these services. In these situations, the worker may, with supervisory approval, approve the extension of services for a specific period of time, not to exceed six months per extension.

Supportive services may be extended following the caseworker's immediate supervisor's approval on Form 427-1021, Case Permanency Plan, Part D. Each extension shall be for a specified period of time not to exceed six months.

ITEM 20. Amend subrule 182.8(4) as follows:

182.8(4) Service management personnel. Service management activities shall be undertaken by persons who meet or are under the direct supervision of persons who meet the minimum education and experience requirements specified in rules 441--185.9(234) and rule 441--185.10(234) for skill development services.

ITEM 21. Amend rule 441--185.1(234) as follows:

Amend the definitions of "Individual provider," "Level of care," "Provider," "Referral worker," and "Service authorization" as follows:

"Individual provider" means a person who seeks certification pursuant to rule 441--185.9(234) or 441--185.10(234) or who is under contract pursuant to 441--Chapter 152 and who delivers rehabilitative treatment and supportive services independent of a partnership, corporation, agency, governmental unit or any other legal entity.

"Level of care" means a level of treatment services within the group care program that is differentiated by the intensity of skill development and therapy services provided, the hours of awake supervision, and the ratio of skill development staff to child. There are three four levels of rehabilitative treatment in the group care program:

1. Community residential.

2. Comprehensive residential.

3. Enhanced comprehensive residential.

4. Highly structured juvenile program.

"Provider" means any natural person, company, firm, association, or other legal entity seeking certification pursuant to rule 441--185.9(234) or 441--185.10(234) or under contract with the department pursuant to this chapter or 441-- Chapter 152.

"Referral worker" means the department worker or juvenile court officer who refers the case to the CACT review organization and who is responsible for carrying out thefollow-up activities after the CACT service necessity determination and service authorization process is completed.

"Service authorization" means the process of service necessity determination and service authorization of scope, amount and duration by the CACT review organization. There are two kinds of service authorization: regular and immediate.

Rescind the definition of "Clinical assessment and consultation team (CACT)."

Add the following new definitions in alphabetical order:

"Adverse authorization action" means an authorization determination decreasing the requested scope, amount, or duration of services, or denying rehabilitative treatment services.

"Authorization action" means an authorization determination approving rehabilitative services.

"Enhanced residential treatment" means a treatment program in a facility licensed under 441--Chapter 115.

"Highly structured juvenile program" means a treatment program for adjudicated delinquent youth, aged 15 to 17, licensed as either community residential facilities under 441-- Chapter 114 or as comprehensive residential facilities under 441--Chapter 115.

"Nonrehabilitative treatment need" means the child and family have a protective, supportive or preventative need for which the child has no identified rehabilitative behavioral health treatment need. Services to address a nonrehabilitative treatment need may be directed at a family member to meet the child's safety, treatment, or permanency need.

"Nonrehabilitative treatment service" means a service to address the nonrehabilitative treatment need of a child. Nonrehabilitative treatment services are designed either to restore a skill or function or teach a new skill or function to achieve maximum independence and functioning. These services may also be directed toward family members to help them meet the treatment, safety, or permanency needs of a child. Nonrehabilitative treatment services are designed to meet treatment needs in one of the following programs:

1. Family-centered program.

2. Family preservation program.

"Rehabilitative treatment need" means a medical-behavior health need of a child with a deficit in function or skill that the child lost or never gained as a result of interference in the normal maturational and learning process due to the child or parental dysfunction. The child must have the capability to benefit from the rehabilitative treatment services.

"Review organization" means the entity designated by the department to make rehabilitative treatment services authorization determination.

ITEM 22. Amend rule 441--185.2(234) as follows:

441--185.2(234) Eligibility.

185.2(1) Need for services. Children and families shall be eligible for rehabilitative treatment services when a referral worker has made a referral to a CACT and the CACT the review organization and the review organization has determined: there is a need for the services.

a. The recipient is a child aged 20 or under and that services are to be directed toward the child.

b. The child has lost or never gained a medical-behavioral health skill or function as a result of interference in the normal maturational and learning process due to an individual or parental dysfunction. The child must have the capability to learn the function or skill.

c. Services are medically necessary and reasonable and are a specific and effective treatment for a child's medical-behavioral health need.

d. The services meet accepted standards of medical-behavioral health practice.

e. The services are based on an evaluation of the child and family.

185.2(2) CACT Rehabilitative treatment services determination. Service necessity for a rehabilitative treatment service shall be determined by the CACT review organization through their clinical judgment based on their review of the categories contained on Form 470-3046, Referral Checklist; the Case Permanency Plan; assessments of the child and family; and other information provided by the referral worker oral information provided by the referral worker. Additional oral or written information may be requested from the referral worker by the review organization when required to make a determination for rehabilitative treatment services. The categories contained on Form 470-3046, Referral Checklist include:

a. Child's risk behaviors: Types of risk behaviors, degree of the risk, and the impact of the risk behaviors on the child, family and community.

b. Concerns regarding the family or environment: Types of concerns, degree of the concern, and the impact of the concerns on the ability to maintain the family as a unit.

c. Service needs: Types of services needed and degree of service intensity needed.

d. Strengths of family or environment: Types of strengths, degree of the strength.

e. Special considerations which may affect the scope, amount and duration of services, including:

(1) Age of the child.

(2) Issues of permanency planning.

(3) Termination of parental rights.

(4) Reunification goals.

(5) Safety and best interests of the child.

(6) Reasonable efforts.

(7) Potential for services to yield desired outcome.

(8) Other considerations.

185.2(3) Court order. If a child and family have been referred to CACT and the CACT has not authorized rehabilitative treatment services, but the services have been ordered by the juvenile court, the referral worker shall refer the case back to the CACT for reconsideration of eligibility in light of the juvenile court's determination for service authorization, and there is an adverse authorization action, but the service has been ordered by the court, the department shall make payment based on the court order, subject to availability of funds. If the CACT continues not to authorize the services ordered by the juvenile court, the department shall make payment subject to availability of authorized funds.

185.2(4) Payment of nonrehabilitative family-centered and family preservation services. If a child and family have been referred for authorization of rehabilitative treatment services and the service authorizer has made an adverse authorization action, the referral worker, with supervisory approval, may determine that a child has a nonrehabilitative treatment need. When a nonrehabilitative treatment need has been determined, the department shall make payment of the nonrehabilitative service subject to the availability of funds.

ITEM 23. Amend rule 441--185.3(234) as follows:

Amend the catchwords and subrule 185.3(1) as follows:

441--185.3(234) Referral to CACT for service authorization.

185.3(1) Role of referral worker. The referral worker shall collect intake and other relevant information on the child and family; coordinate with existing local case review processes; assess the child and family to determine if a referral to the CACT for service authorization is appropriate and what kind of service authorization should be requested; . The referral worker shall provide the review organization with specific oral information required for authorization and provide a specific recommendation regarding the appropriate scope, amount, and duration, and expected outcomes of the services. The referral worker may provide additional oral or written information to the review organization.

Rescind subrule 185.3(2) and insert the following new subrule in lieu thereof:

185.3(2) Time frames. The referral for rehabilitative service authorization shall be conducted before initiation of services unless there is an imminent risk of placement and an emergency protective need to initiate family preservation services after hours, on weekends, or on holidays. Prior to the referral for family preservation services being made after hours, on weekends, or on a holiday, the referral worker shall obtain supervisory approval. When the referral for family preservation services is made after hours, on weekends, or on a holiday, the referral for rehabilitative service authorization shall be conducted the next business day.

Further amend rule 441--185.3(234) by adding the following new subrules:

185.3(3) Initial authorization. The referral worker shall contact the review organization and provide adequate details of the child's needs from which an authorization decision can be made, including:

a. Demographic information.

b. Source, date, and type of child and family assessments.

c. A diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, whenever available.

d. Medical-behavior health symptoms.

e. Child's history and risk factors.

f. Family history and risk factors.

g. Strengths of the child, family, or environment.

h. Permanency goal.

i. Symptoms the service is expected to alleviate.

j. Past and current services provided to the child and family and the outcome of the service.

k. The child's capability of benefiting from rehabilitative treatment services.

185.3(4) Review of previously authorized services. At least two weeks prior to the final eligibility date of the previously authorized services, the referral worker shall contact the review organization for continued authorization.

The referral worker shall provide the review organization with adequate details of the child's needs from which a reauthorization decision can be made, including:

a. Identified change or lack of change in the child, the child's family, if applicable, and in the service outcomes as identified in the provider progress report of treatment plan.

b. Continuing rehabilitative treatment need.

c. Utilization of the previous services authorized.

d. Specific progress or lack of progress made by the child toward the service outcomes identified in the last review.

185.3(5) Follow-up to service authorization.

a. The referral worker shall be responsible for these activities following service authorization:

(1) Incorporating the service authorization into the Case Permanency Plan, consisting of forms 427-1020, 427-1022, and 427-1023, if the service authorization is not subject to further court action, or a reasonable facsimile containing the same information.

(2) Presenting service authorization information to the court if further court action is planned.

(3) Assisting the family in selecting an appropriate provider if the authorized rehabilitative treatment service is family-centered or family preservation. If the authorized rehabilitative treatment service is family foster care or group care, the referral worker is responsible for selecting an appropriate provider. Once services have been arranged, the referral worker shall complete Form 470-3055, Referral of Client for Rehabilitative Treatment and Supportive Services, and forward a copy to the provider and a copy to the department when the referral worker is with juvenile court. When the referral worker is a juvenile court officer, the referral worker is also responsible for ensuring that information necessary for entry into the Family and Children's Services System (FACSS) is submitted to the department.

(4) Working with the child or family to apply for Medicaid, or, if the family is unwilling to apply and the case is under the jurisdiction of the juvenile court, the referral worker shall request a court order directing the parents to apply on the child's behalf.

EXCEPTION: When the child's or family's countable resources exceed $10,000 according to the department of public health's 641-- subrule 75.4(2), no application for Medicaid need be made.

b. The provider of services, working with the family and the referral worker, is responsible for developing the detailed treatment plan in compliance with the Case Permanency Plan and the authorization.

ITEM 24. Amend rule 441--185.4(234) as follows:

Amend the catchwords and subrules 185.4(1) to 185.4(4) as follows:

441--185.4(234) Clinical assessment and consultation teams Review organization.

185.4(1) CACT membership. The team shall consist of at least a full-time CACT coordinator. Other members of the team shall be identified in accordance with the resources allocated by the department.

185.4(2) CACT qualifications Qualifications for authorizing services. Every member of the CACT staff member authorizing services shall be a physician or licensed practitioner of the healing arts and have at least three years of experience in the delivery of child welfare or juvenile justice services in a public or private agency, or in private practice. In the event sufficient qualified professionals cannot be secured, the department may elect to secure persons from out of state with licensure equal to that of the licensure of the licensed practitioner of the healing arts. These persons shall become licensed within one year in Iowa.

185.4(3) 185.4(2) Purposes Components of CACT service authorization. In accordance with department policies and procedures, the CACT service authorization process shall have the following purposes regarding rehabilitative treatment services include the following:

a. Determination that an adequate assessment has been made on which to base a determination regarding service necessity.

b. Determination of service necessity.

c. Authorization of scope, amount, and duration of services, and identification of desired service outcome.

d. Provision of case authorization-specific clinical consultation to the referral worker.

e. Review of service necessity for currently authorized rehabilitative treatment services.

f. Determination of service necessity for additional rehabilitative treatment services, when applicable.

g. Participation in the appeal process.

h. Recommendation, when appropriate, regarding services outside the scope of rehabilitative treatment services.

185.4(4) 185.4(3) Responsibilities of CACT members the review organization. Each CACT member The review organization shall have the following responsibilities:

a. Identify need for additional diagnosis or evaluation of the child and family.

b. Carry out the service authorization process to determine rehabilitative service needs and authorize rehabilitative services under the rehabilitative treatment program.

c. Complete required documentation of the service authorization process.

d. Provide case authorization-specific consultation to the referral worker upon request.

e. Ensure that service authorization is completed within the established time frames.

f. Complete the required documentation of all service authorization activities.

g. Maintain necessary records for service authorizations.

h. Maintain records of appeals.

i. Specify the amount and duration for the authorized service, issue a notice of decision, and notify the referral worker to facilitate the initiation of the service.

Insert the following new subrule 185.4(4) as follows:

185.4(4) Service authorization documentation. Documentation shall be maintained to support that the authorization decision is appropriate in scope, amount, and duration. The authorized services shall match the identified need of the child. The review organization shall clearly document authorization rationale.

a. The review organization shall document the following components of the service necessity determination and the service authorization on Form 470-3454, Rehabilitative Service Authorization:

(1) Demographic information.

(2) Source, date, and type of child and family assessments.

(3) A diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, whenever available.

(4) Specific medical-behavioral health need of the child.

(5) Child's history and risk factors.

(6) The function or skill that the child lost or never gained as a result of interference in the normal maturational and learning process due to individual or parental dysfunction.

(7) Individual or parental dysfunction.

(8) Family history and risk factors.

(9) Strengths of the child, family, or environment.

(10) Permanency goal.

(11) Expected service outcome.

(12) Past and current services provided to the child and family.

(13) The child's capability of benefiting from rehabilitative treatment services.

(14) Factors and severity of factors.

(15) Progress the child has made to alleviate themedical-behavioral health need.

(16) Determination as to whether an adequate assessment has been made on which to base a determination regarding service necessity.

(17) Authorized scope, amount, and duration of services.

(18) Authorization justification.

(19) Identification of reasons if an authorization is different from what was recommended by the referral worker.

(20) Date the authorization is completed.

b. The review organization shall complete a notice of decision.

c. The review organization shall generate Form 470-3055, Referral of Client for Rehabilitative Treatment and Supportive Services, for completion by the referral worker.

d. The review organization shall forward Form 470-3454, Rehabilitative Service Authorization, a copy of the notice of decision, and Form 470-3055, Referral of Client for Rehabilitative Treatment and Supportive Services, to the referral worker immediately upon completion of the authorization process.

Rescind subrules 185.4(5) and 185.4(6) and insert the following new subrules in lieu thereof:

185.4(5) Time frames. The review for service necessity and service authorization shall be completed within the following time frames:

a. The service authorization decision shall be rendered by the review organization during the contact by the referral worker unless additional information is required.

b. If the review organization requires additional information, the review organization shall render a decision within one working day of receipt of the additional information.

185.4(6) Review of services previously authorized. The review organization is responsible for reviewing previously authorized services. This review of services shall occur at the request of the referral worker two weeks prior to the final eligibility date of previously authorized services if the services are to continue.

a. The purpose of this review by the review organization shall be to consider the following changes in service authorization:

(1) Scope of service.

(2) Amount of service.

(3) Duration of service.

b. The review of service authorization shall be carried out according to the process and time frames described in subrules 185.4(3) to 185.4(6).

c. The review organization shall document adequate details of the child's needs from which the reauthorization decision was made, including:

(1) Identified change or lack of change in the child, the child's family, if applicable, and in the service outcomes as identified in the provider's progress report or treatment plan.

(2) Rehabilitative service need.

(3) Use of the previous services authorized.

(4) Documentation of the child's ability to benefit from the service.

Rescind and reserve subrule 185.4(7).

ITEM 25. Rescind rules 441--185.5(234), 441-- 185.6(234), and 441--185.7(234) and insert the following new rules in lieu thereof:

441--185.5(234) Adverse authorization actions by the review organization. Denial of requested rehabilitative treatment services shall be based on one or more of the following:

1. There is inadequate information upon which to base a determination for rehabilitative service need.

2. The child does not have a rehabilitative service need.

3. Services requested are directed to the parents to meet the treatment, safety, or permanency needs of the child.

4. The services requested are nonrehabilitative or designed to teach a new skill or function.

5. The scope, amount, or duration of services is not reasonable or is not a specific and effective treatment for the child's medical-behavioral health care need.

6. The scope, amount, or duration of services does not meet accepted standards of medical-behavioral health practice.

7. The service requested would be considered a duplicated Medicaid payment: for example, the child or youth is currently in a psychiatric medical institution for children.

8. Upon review of previously authorized services, there has been no progress in alleviating the rehabilitative treatment need.

9. The requested scope, amount, or duration does not meet family preservation, family-centered services, foster care, or group care program requirements.

441--185.6(234) Appeals. Adverse authorization actions taken by the review organization shall be subject to a reconsideration process by the review organization before an appeal shall be heard under 441--Chapter 7.

185.6(1) Adverse action reconsideration. The client may request a reconsideration of any adverse action taken by the review organization by sending a letter requesting a review to the review organization. This reconsideration shall be requested within 30 calendar days from the date the notice of decision is issued. The review organization shall complete the reconsideration and issue a notice of decision within 7 calendar days of the date of the client's request.

185.6(2) Appeal rights. If the client is dissatisfied with the reconsideration decision by the review organization, the client may file an appeal with the department under 441--Chapter 7. This appeal shall be requested within 30 calendar days from the date the reconsideration notice of decision is issued.

441--185.7(234) Transition to the review organization. A transition phase shall exist for authorization of services from August 15, 1998, until October 31, 1998. Prior to October 31, 1998, authorization may be given by CACT teams as provided by department rules at 441--Chapter 185 in effect as of August 14, 1998.

ITEM 26. Rescind and reserve rule 441--185.8(234).

ITEM 27. Amend subrule 185.10(5), paragraph "a," subparagraph (2), as follows:

(2) When any changes are made by CACT the review organization to the identified medical-behavioral health care need of the child listed on Form 470-3055, Referral of Client for Rehabilitative Treatment and Supportive Services.

ITEM 28. Amend rule 441--185.24(234) as follows:

441--185.24(234) Duration of services. Family-centered services shall not be authorized for more than six months from the initial day of contact by the provider. Prior approval shall be obtained from the CACT review organization for services to extend beyond the time period authorized initially.

ITEM 29. Amend rule 441--185.63(234) as follows:

441--185.63(234) Duration of services. Family foster care rehabilitative treatment services shall not be authorized for more than six months from the initial day of service provision by the provider. Prior approval shall be obtained from the CACT review organization for services to extend beyond the time period authorized initially.

ITEM 30. Amend rule 441--185.84(234) as follows:

441--185.84(234) Additional services provided in group care. Additional therapy and counseling services to the child that are in excess of frequency and intensity of services set forth in the core group of services and which are authorized by CACT approved by the review organization pursuant to rule 441--185.5(234) 441--185.4(234) shall be provided on an individual unit basis. Units of additional therapy and counseling provided in group care shall be defined and reimbursed in half-hour increments, with a billable unit being face-to-face contact with the child. The provider may bill for additional units after documenting that the services are in excess of that required in the daily rate.

ITEM 31. Amend rule 441--185.85(234) as follows:

441--185.85(234) Duration of services. Group treatment services shall not be authorized for more than six months from the initial day of service provision by the provider. Prior approval shall be obtained from the review organization for services to extend beyond the time period authorized initially.

ITEM 32. Amend rule 441--202.2(234) as follows:

Amend subrule 202.2(2) as follows:

202.2(2) The need for foster care placement and social and other related services including, but not limited to, medical, psychiatric, psychological, and educational services shall be determined by an assessment of the child and family to determine their needs and appropriateness of services. Assessments include the educational, physical, psychological, social, family living, and recreational needs of the child and the family's ability to meet those needs. The assessment is a continual process to identify needed changes in service or placement for the child. The need for treatment services shall be determined by a clinical assessment and consultation team (CACT) the review organization pursuant to rule 441-- 185.2(234).

Amend subrule 202.2(5), introductory paragraphs, as follows:

202.2(5) The need for foster care and the efforts to prevent placement shall be evaluated by a review committee prior to placement or, for emergency placements only, within 30 days after the date of placement. For children who are mentally retarded or developmentally disabled and receive case management services, this requirement may be met by the interdisciplinary staffing described in 441--Chapter 24, as long as the regional administrator approves, the department worker attends the staffing, and the staffing meets the requirements of paragraphs "b" to "h" below. For rehabilitative treatment services for which eligibility is determined by a clinical assessment and consultation team (CACT) as directed in rule 441--185.2(234), this team may conduct the evaluation according to requirements of paragraphs "b" through "h" listed below.

The review shall meet the following requirements:

ITEM 33. Amend subrule 202.4(5), paragraph "f," as follows:

f. The treatment needs of the child as determined by a clinical assessment and consultation team (CACT) the review organization pursuant to rule 441--185.2(234).

ITEM 34. Amend subrule 202.6(1), introductory paragraph, as follows:

202.6(1) At the time of placement, the worker shall provide the facility with specific information regarding the child including the case permanency plan, the results of a physical examination, the child's medical needs including special needs of HIV, behavioral patterns, and educational arrangements, the placement contract or agreement, and medical authorizations, clinical assessment and consultation team (CACT) service authorizations, and other releases as needed.

ITEM 35. Amend rule 202.17(234) as follows:

Amend subrule 202.17(1), paragraph "d," introductory paragraph, as follows:

d. Notwithstanding the statewide appropriation established in this subrule, a budget established in a region's group care plan pursuant to Iowa Code section 232.143 may be exceeded, a group care placement may be ordered, and state payment may be made if a clinical assessment and consultation team the review organization finds that the placement is necessary to meet the child's service needs and if the region has additional funds transferred from another region or if the region is within 5 percent of its group care budget target figure pursuant to 441--paragraph 202.17(1)"c."

Amend subrule 202.17(2), first unnumbered paragraph, as follows:

The plans shall also ensure potential group care referrals are reviewed by a clinical assessment and consultation team the review organization prior to submission of a recommendation for group care placement to the court.

ARC 8121A

The Council on Human Services adopted these amendments June 10, 1998. Notice of Intended Action regarding these amendments was published in the Iowa Administrative Bulletin on May 6, 1998, as ARC 7965A.

These amendments implement the use of three separate demand letters for the Family Investment Program (FIP), Refugee Cash Assistance (RCA), and food stamps; revise policy regarding the collection of food stamp agency error claims; and implement changes to the collection of food stamp claims mandated by federal law. In addition, references and form names and numbers are updated.

* Policy is revised to provide for the issuance of three food stamp demand letters for FIP, RCA, and food stamps instead of the current single form used for each program. Clients will receive a different demand letter for repayment depending on whether their overissuance was due to an agency error, client error, or intentional program violation. The use of three separate letters will be less confusing for participants and former participants. This change was made for food stamps in response to the Bliek lawsuit, and by making the same change for FIP and RCA, it will be less confusing to persons who have claims in multiple programs.

* Policy is revised to require the collection of agency error claims for overissued food stamps by benefit reduction for current recipients and by state tax refund offset or federal offset for households not participating in the program. Under current policy, if a client does not voluntarily make arrangements to repay an agency error claim, collection is not pursued after the issuance of four demand letters. Under revised policy, which is required by Section 844 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, claims due to agency errors of active clients will be recouped in the same manner as inadvertent household error claims (10 percent reduction in benefit allotment), and agency errors of nonparticipating households will be referred for state or federal offset.

* Policy is clarified regarding repayment of claims. Payment shall be applied only to eligible overpayments. An eligible overpayment means any overpayment which is not under investigation or appeal. If there is more than one overpayment, payments shall be applied first to all overpayments with an agreement, in chronological order of discovery, and then to overpayments without an agreement, also in chronological order of discovery.

* Policy is revised regarding the order of repayment of claims for food stamps. For food stamps, payment shall also be applied first to all overpayments with an agreement and then to overpayments without an agreement. Within those two groupings, payment shall be applied first to state-only overpayments in chronological order of discovery, then to intentional program violation (IPV) overpayments in chronological order of discovery, then to inadvertent household error (IHE) overpayments in chronological order of discovery, and then to agency error overpayments in chronological order of discovery.

* Policy is revised to make state income tax offset optional as food stamp regulations require that the full amount of the debt cannot be referred for both federal and state offset. Benefit reduction shall be used for current recipients and either state tax offset or federal offset shall be used for households no longer participating in the program.

* Changes are made to the federal process for collection of food stamp claims mandated by the Debt Collection Improvement Act (DCIA) of 1996. Rules were previously adopted, but have not yet been implemented due to a stay in any collection activity by the Bliek lawsuit, to allow offset against federal income tax refunds, unemployment compensation, or other federal payments for food stamp program overpayments. Use of federal tax offset was optional, but is now mandatory. States have been given until January of 1999 to be up and running. Changes in the federal process are as follows:

[zeta] The Department of the Treasury is designated as the primary federal collection agent, rather than the Internal Revenue Service.

[zeta] Setoffs will not be made against unemployment compensation as the setoffs would not be cost-effective.

[zeta] Persons who are not participating in the food stamp program who are delinquent in repaying their food stamp overissuance shall be subject to collection action through the Treasury Offset Program (TOP) which includes, but is not limited to, federal tax refund offset, federal salary offset, and administrative offset.

Persons are delinquent in repaying their food stamp overissuance if a repayment agreement has not been signed and 180 days have elapsed since the date of the second demand letter minus any days the claim was not subject to collection action because of an appeal or because the claim was referred for court prosecution or a repayment agreement has been signed but the individual responsible for repaying the debt has failed to make the agreed-upon payments and has failed to make up the missed payments. The individual shall be referred to TOP when 180 days have elapsed since the first of the month following the month that the individual failed to make the agreed-upon payment and has not subsequently made up the missed payment.

The unpaid balance of the claims must exceed $25 and the claims must be more than three months and less than ten years old as of January 31 of the offset year. Claims which have had a final judgment entered are not subject to the ten-year time limit.

[zeta] The Department of the Treasury shall charge the individual for the cost of effecting the first offset and the Department for any other offsets.

[zeta] Individuals shall be notified 60 days prior to the time the Department refers the claim to TOP for offset to allow them to sign an agreement to repay, renegotiate an agreement, and pay off the delinquency. Clients may also request a review of the delinquent status of the claim from the Department of Inspections and Appeals (DIA) within the 60 days, and DIA shall determine if the claim is past due and legally enforceable and shall notify the individual in writing of the decision.

These amendments are identical to those published under Notice of Intended Action.

These amendments are intended to implement Iowa Code sections 217.34, 234.6, and 421.17, subsection 21, and Iowa Code chapter 239B.

These amendments shall become effective August 5, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 7.5(6) as follows:

7.5(6) Appeals of family investment program (FIP) and refugee cash assistance (RCA) overpayments. Subject to the time limitations described in subrule 7.5(4), a person's right to appeal the existence, computation, and amount of a FIP or RCA overpayment begins when the person receives the first Form 470-2616, Demand Letter for ADC/FIP FIP/RCA Agency Error Overissuance, Form 470-3489, Demand Letter for FIP/RCA Intentional Program Violation Overissuance, or Form 470-3490, Demand Letter for FIP/RCA Client Error Overissuance, from the department of human services, informing the person of the FIP or RCA overpayment. A hearing shall not be held if an appeal is filed in response to a second or subsequent Demand Letter for ADC/FIP FIP/RCA Agency Error Overissuance, Demand Letter for FIP/RCA Intentional Program Violation Overissuance, or Demand Letter for FIP/RCA Client Error Overissuance. Subject to the time limitations described in subrule 7.5(4), a person's right to appeal the recovery of an overpayment through benefit reduction, as described at rules rule 441--46.5(239) and 46.25(239) (239B), but not the existence, computation, or amount of an overpayment, begins when the person receives Form 470-0486, Notice of Decision, informing the person that benefits will be reduced to recover a FIP or RCA overpayment.

ITEM 2. Amend rule 441--11.1(217,421), definitions of "Debtor," "Public assistance," "Repayment agreement," and "Written notification," as follows:

"Debtor" shall mean a current or former recipient of public assistance (usually the head of the household) that has been determined by the department to be responsible for the repayment of a particular overpayment. For food stamps, "debtor" shall include all adult members of the food stamp household participating at the time the overpayment occurred.

"Public assistance" shall mean aid to families with dependent children family investment program, food stamps, medical assistance, state supplemental assistance, PROMISE JOBS, transitional child care, and refugee cash assistance.

"Repayment agreement" shall mean an agreement entered into voluntarily between the department and the debtor for the repayment of overpayment(s) overpayments.

Agreements shall be made on Form PA-3164-0 470-0495, Agreement to Repay Overpayment Repayment Contract, Form PA-3167-0, Agreement to Repay Overpayment after Probation, Form FP-2322-0 470-0338, Demand Letter for Food Stamp Agency Error Overissuance, Form 470-3486, Demand Letter for Food Stamp Intentional Program Violation Overissuance, Form 470-3487, Demand Letter for Food Stamp Inadvertent Household Error Overissuance, Form 470-2616, Demand Letter for ADC FIP/RCA Agency Error Overissuance, Form 470-3489, Demand Letter for FIP/RCA Intentional Program Violation Overissuance, Form 470-3490, Demand Letter for FIP/RCA Client Error Overissuance, and Form 470-2891, Demand Letter for Medicaid or State Supplementary Assistance Overpayment.

"Written notification" shall refer to the written notification sent to a current or former recipient of public assistance by the department on Form PA-3168-0 470-1668, "Pre-Debt Setoff Letter" Notice of Setoff of an Iowa Income Tax Refund for Debts Owed the Department of Human Services, Form 427-0538, Notice of Income Offset Against State Warrants for Debts Owed the Department of Human Services, and PA-3169-0, "Debt Setoff Letter." Form 427-0539, Notice of Income (Payroll) Offset Against State Warrants for Debts Owed the Department of Human Services.

Further amend rule 441--11.1(217,421) by adding the following new definition in alphabetical order:

"Eligible overpayment" means any overpayment which is not under investigation or appeal.

ITEM 3. Amend rule 441--11.2(217,421), introductory paragraph and subrule 11.2(1), as follows:

441--11.2(217,421) Accounts. The department shall maintain an account for each overpayment that has occurred for each debtor. The account shall contain the following:

11.2(1) Debtor A debtor name and account number.

ITEM 4. Amend subrules 11.3(1) and 11.3(2) as follows:

11.3(1) Application of payment to single program area. Payment shall be applied only to eligible overpayments. If there is more than one eligible overpayment in a program, the payment shall be applied first to the overpayment which was established first. Any remaining amount shall be applied to the next overpayment(s) all overpayments which have an agreement in chronological order of discovery and then to overpayments which do not have an agreement in chronological order of discovery until all overpayments have been paid in full or the full payment amount has been exhausted.

For food stamps, payment shall also be applied first to all overpayments with an agreement and then to overpayments without an agreement. Within those two groupings, payment shall be applied first to state-only overpayments in chronological order of discovery, then to intentional program violation (IPV) overpayments in chronological order of discovery, then to inadvertent household error (IHE) overpayments in chronological order of discovery, and then to agency error overpayments in chronological order of discovery.

11.3(2) Application of payment to multiple program areas. If there are overpayments in more than one program area of public assistance, payments received shall be applied to those program areas as indicated by the mode of repayment (food stamp coupons, ADC FIP benefits) or as indicated by the client at the time of payment.

ITEM 5. Amend rule 441--11.4(217,421) as follows:

Amend subrule 11.4(1), paragraph "a," introductory paragraph, as follows:

a. A claim against a debtor will may be made by the department for public assistance overpayments when:

Amend subrules 11.4(3) and 11.4(4), introductory paragraphs, as follows:

11.4(3) Pre-setoff notice. The department shall mail a Pre-Debt Setoff Letter, Form PA-3168-0, written notification to a debtor to inform the debtor of the amount the department intends to claim and apply to overpayment(s) overpayments in each program when:

11.4(4) Method for division of joint payments. When either spouse wishes to request a division of a jointly or commonly owned right to payment, a written request shall be submitted to the department within 15 days after the Pre-Debt Setoff Letter, Form PA-3168-0 written notification is mailed. When the request is received within the 15-day limit, the spouse's proportionate share of a jointly or commonly owned right to payment, as determined by the department of revenue and finance, shall be released by the department of revenue and finance unless:

Amend subrules 11.4(5), 11.4(6), and 11.4(7) as follows:

11.4(5) Appeal rights. When a debtor wishes to contest the claim of the department, a written request shall be submitted to the department within 15 days after the Pre-Debt Setoff Letter, Form PA-3168-0 written notification is mailed. When the request is received within the 15-day limit, a hearing shall be granted pursuant to rules in 441--Chapter 7.

If the department is upheld in the final decision, the setoff process shall continue and the refund, rebate, or other state payment shall be applied to the appropriate delinquent overpayment(s) overpayments. If the department is reversed in the final decision, the debtor's refund, rebate, or other state payment shall be released to the debtor by the department of revenue and finance.

11.4(6) Debt setoff. If the department has not received a request for an appeal hearing or a request for division of a jointly or commonly owned right to payment within 15 days after the date the Pre-Debt Setoff Letter, Form PA-3168-0 written notification is mailed, the department shall notify a debtor of the final decision by mailing the Debt Setoff Credit Letter, Form PA-3169-0 470-1667 to the debtor.

11.4(7) Application of setoff. The department shall apply any setoff received from the department of revenue and finance as a result of this rule to the debtor's overpayment(s) overpayments as indicated on the Pre-Debt Setoff Letter, Form PA-3168-0, written notification mailed to the debtor and in accordance with rule 441--11.3(217,421).

Any amount remaining after the setoff shall be released back to the debtor individual.

ITEM 6. Amend rule 441--11.5(234) as follows:

441--11.5(234) Setoff against federal income tax refund, unemployment compensation, or other federal payments, including, for example, federal employee wages.

11.5(1) Criteria for setoff.

a. A claim against a debtor shall be made by the department for food stamp program overpayments when: Individuals not participating in the food stamp program shall be subject to collection action through the treasury offset program (TOP) which includes, but is not limited to, federal salary offset and federal tax refund offset. Individuals shall be referred to TOP if they are delinquent in repaying their food stamp overissuance and there is a claim or combination of claims with an unpaid balance which exceeds $25. No claim which is less than three months old or more than ten years old as of January 31 of the offset year shall be referred. Exception: Claims which have had a final judgment entered are not subject to the ten-year time limit.

Individuals are delinquent in repaying their food stamp overissuance if:

(1) A debtor has failed to negotiate a repayment agreement, or A repayment agreement has not been signed and 180 days have elapsed since the date of the second demand letter minus any days the claim was not subject to collection action because of an appeal or because the claim was referred for court prosecution.

(2) A repayment agreement is not current, and A repayment agreement has been signed but the individual responsible for repaying the debt has failed to make the agreed-upon payments and has failed to make up the missed payments. The individual shall be referred to TOP when 180 days have elapsed since the first of the month following the month that the individual failed to make the agreed-upon payment and has not subsequently made up the missed payment.

(3) The cumulative balance of the applicable overpayments in subparagraphs (1) and (2) exceeds $50.

b. A claim against a debtor an individual will not be made referred to TOP by the department of inspections and appeals (DIA) for overpayments when:

(1) The overpayment is under investigation for fraud or is in an appeal status, or

(2) The overpayment is being recovered through grant or benefit reduction.

11.5(2) Setoff against federal income tax refund under TOP. The department DIA shall, by October December 1 of each year, submit a notification of liability for delinquent claims to the Internal Revenue Service Department of the Treasury.

11.5(3) Pre-setoff notice. The department DIA shall mail a pre-setoff notice Form 470-3488, Treasury Offset Program (TOP) 60-Day Notice to a debtor to inform the debtor of identifying the amount the department intends to claim and apply to overpayments in the food stamp program when the department is notified by the Internal Revenue Service that the debtor is entitled to a federal income tax refund or other federal payment refer to TOP for offset.

11.5(4) Warrant offset. The department shall mail a warrant offset notice to a debtor to inform the debtor of the amount the department intends to claim and apply to overpayments in the food stamp program when the department makes claim against the debtor's unemployment compensation or other federal payment. Offset fee. For each year the Treasury Department effects an offset against an individual referred to TOP, Treasury will charge the individual for one offset.

11.5(5) Appeal rights. When a debtor an individual wishes to contest the delinquent status of a claim of the department as identified by DIA, a written request shall be submitted to the department DIA within 15 60 days after of the date of the pre-setoff pre-offset notice or warrant notice is mailed. When the request is received within the 15-day 60-day limit, a hearing review shall be granted pursuant to rules in 441--Chapter 7.

If the department is upheld in the final decision, the setoff process shall continue and the refund, unemployment compensation, or other federal payment shall be released to the debtor by the Internal Revenue Service. DIA shall determine if the claim is past due and legally enforceable and shall notify the individual in writing of the decision.

11.5(6) Application of setoff. The department DIA shall apply any setoff received as a result of this rule to the debtor's individual's food stamp overpayments.

Any amount remaining after the setoff shall be released back to the debtor individual.

ITEM 7. Amend rule 441--65.21(234) as follows:

Amend subrule 65.21(1) as follows:

65.21(1) Time period. Claims Inadvertent household error and agency error claims shall be calculated back to the month the error originally occurred to a maximum of three years prior to month of discovery of the overissuance.

Rescind and reserve subrule 65.21(2).

Amend subrule 65.21(4) as follows:

65.21(4) Demand letters. Households which have inadvertent household error (IHE) food stamp claims shall return the repayment agreement no later than 20 days after the date the demand letter is mailed. Households which have intentional program violation (IPV) claims shall return the repayment agreement no later than ten days after the date the first demand letter is mailed. For agency error and inadvertent household error, IHE households which do not return the repayment agreement by the due date or do not timely request an appeal, allotment reduction shall occur with the first allotment issued after the expiration on the Notice of Adverse Action time period. For intentional program violation, IPV households which do not return the repayment agreement by the due date, allotment reduction shall occur with the first next month's allotment issued ten days after the date of the demand letter.

Further amend rule 441--65.21(234) by adding the following new subrule 65.21(6):

65.21(6) Collection of claims. All claims for overissued food stamps can be collected by allotment reduction. Individuals not participating in the food stamp program who are 180 days delinquent in repaying their overissuance will be subject to collection action through the treasury offset program (TOP) which includes, but is not limited to, federal salary offset and federal tax refund offset as outlined in rule 441--11.5(234).

ARC 8120A

The Council on Human Services adopted these amendments June 10, 1998. Notice of Intended Action regarding these amendments was published in the Iowa Administrative Bulletin on May 6, 1998, as ARC 7966A.

These amendments provide that a family's 25 percent FIP grant reduction for noncooperation with child support recovery requirements shall be lifted beginning with the month after the parent or other caretaker expresses willingness to cooperate. However, the action to remove the grant reduction will still be delayed until cooperation has actually occurred. These changes will provide consistency with Medicaid rules on lifting a CSRU sanction.

Under current rules, if the parent or other caretaker fails to cooperate with the income maintenance (IM) unit, the FIP grant reduction is lifted effective the first of the next calendar month after cooperation has occurred. For example, if the client cooperates on April 12, the grant reduction is removed beginning with the May FIP grant.

However, if the noncooperation was with the child support recovery unit (CSRU), the grant reduction is lifted effective the first of the next calendar month after IM is notified by CSRU that cooperation has occurred. For example, if IM is notified on April 20 that the client cooperated on March 29, the grant reduction is lifted beginning with the May FIP grant.

Under these amendments, the grant reduction is lifted effective the first of the next calendar month after the client expressed willingness to cooperate.

Example 1: If the previously noncooperating client expresses willingness to cooperate on March 29, and on April 20 CSRU notifies IM that the client carried out the cooperation requirements on April 18, the grant reduction is lifted retroactive beginning with the April FIP grant.

Example 2: If the client expresses willingness to cooperate on April 1, and on April 25 CSRU notifies IM that the client complied with cooperation requirements on April 15, the grant reduction is lifted beginning with the May FIP grant.

Under these amendments, regardless of the date that the client may express willingness to cooperate, any action to lift the grant reduction is still delayed until the client has actually cooperated with IM, or until IM is notified by CSRU that the client has cooperated.

These amendments are identical to those published under Notice of Intended Action.

These amendments are intended to implement Iowa Code section 239B.2(6).

These amendments shall become effective September 1, 1998.

The following amendments are adopted.

ITEM 1. Amend subrule 40.27(5) as follows:

Amend paragraph "i" as follows:

i. When a sanction under paragraph 41.22(6)"f" or 441--subrule 41.25(8) is implemented or removed, the change shall be effective the first of the next calendar month after the change has occurred or notification as described in these rules that subrule has been received.

Further amend subrule 40.27(5) by adding the following new paragraph "j":

j. When a sanction under 441--paragraph 41.22(6)"f" is implemented, the change shall be effective the first of the next calendar month after the change has occurred when income maintenance determines noncooperation or after income maintenance receives notification from the child support recovery unit (CSRU) when CSRU determines noncooperation. When the sanction is removed, the change shall be effective the first of the next calendar month after the recipient has expressed willingness to cooperate as described in 441--paragraph 41.22(6)"f." However, action to remove the sanction shall be delayed until cooperation has actually occurred or until notification has been received from CSRU that the client has cooperated.

ITEM 2. Amend subrule 41.22(6), paragraph "f," as follows:

f. Failure to cooperate shall result in a sanction to the family. The sanction shall be a deduction of 25 percent from the net cash assistance grant amount payable to the family prior to any deduction for recoupment of a prior overpayment. When the income maintenance unit determines noncooperation, the sanction shall be implemented after the noncooperation has occurred. The sanction shall remain in effect until the client has cooperated expressed willingness to cooperate. However, any action to remove the sanction shall be delayed until cooperation has occurred. When the child support recovery unit (CSRU) makes the determination, the sanction shall be implemented upon notification from CSRU to the income maintenance unit that the client has failed tocooperate. The sanction shall remain in effect until the income maintenance unit is notified by CSRU that the client

has cooperated expressed to either income maintenance or CSRU staff willingness to cooperate. However, any action to remove the sanction shall be delayed until income maintenance is notified by CSRU that the client has cooperated. When the family is also subject to sanction under paragraph 41.25(8)"g," the sanction for failure to cooperate in obtaining support shall be calculated as though the sanction at paragraph 41.25(8)"g" does not exist.

ARC 8112A

The Council on Human Services adopted this amendment June 10, 1998. Notice of Intended Action regarding this amendment was published in the Iowa Administrative Bulletin on May 6, 1998, as ARC 7968A.

This amendment adds five counties, Adams, Humboldt, Lyon, Mahaska, and Monroe, to the Elderly Waiver program effective October 1, 1998. With this addition, only five counties remain without the Elderly Waiver program: Audubon, Henry, Shelby, Sioux, and Taylor.

This amendment is identical to that published under Notice of Intended Action.

This amendment is intended to implement Iowa Code section 249A.4.

This amendment shall become effective October 1, 1998.

The following amendment is adopted.

Amend subrule 83.22(1), paragraph "b," as follows:

b. A resident of one of the following counties:

Adair	Davis	Jefferson	Plymouth
Adams	Decatur	Johnson	Pocahontas
Allamakee	Delaware	Jones	Polk
Appanoose	Des Moines	Keokuk	Pottawattamie
Benton	Dickinson	Kossuth	Poweshiek
Black Hawk	Dubuque	Lee	Ringgold
Boone	Emmet	Linn	Sac
Bremer	Fayette	Louisa	Scott
Buchanan	Floyd	Lucas	Story
Buena Vista	Franklin	Lyon	Tama
Butler	Fremont	Madison	Union
Calhoun	Greene	Mahaska	Van Buren
Carroll	Grundy	Marion	Wapello
Cass	Guthrie	Marshall	Warren
Cedar	Hamilton	Mills	Washington
Cerro Gordo	Hancock	Mitchell	Wayne
Cherokee	Hardin	Monona	Webster
Chickasaw	Harrison	Monroe	Winnebago
Clarke	Howard	Montgomery	Winneshiek
Clay	Humboldt	Muscatine	Woodbury
Clayton	Ida	O'Brien	Worth
Clinton	Iowa	Osceola	Wright
Crawford	Jackson	Page
Dallas	Jasper	Palo Alto

ARC 8135A

Chapter 11 is being amended by adding a new subrule establishing criteria and procedures for requesting a waiver of an existing rule pertaining to applications for permanent, temporary, resident physician, or special licensure.

Notice of Intended Action was published in the April 8, 1998, Iowa Administrative Bulletin as ARC 7952A. No comments were received. The adopted amendment is identical to that published under Notice except that in 11.9(3)"f" the words "at any time" have been added. This amendment was approved at the June 4, 1998, meeting of the Board of Medical Examiners.

This amendment will become effective August 5, 1998.

This amendment is intended to implement Iowa Code chapters 147, 148, 150, 150A, and 272C.

The following amendment is adopted.

Amend rule 653--11.9(147,148,150,150A) by adding the following new subrule:

11.9(3) Waivers. The board may grant a waiver of a board rule pertaining to applications for permanent licensure, temporary licensure, resident physician licensure, or special licensure.

a. Compliance with statute. No waiver may be granted from a requirement which is imposed by statute. Any waiver must be consistent with statute.

b. Criteria. A waiver under this subrule may be granted only upon a showing of all the following:

(1) Because of special circumstances, application of the rule would impose an undue burden or hardship on the requester;

(2) Granting the waiver would not adversely affect the public interest; and

(3) Granting the waiver would provide substantially equal protection of public health and safety as would compliance with the rule.

c. Requirements. A request for a waiver shall be made at any time during the 120-day application cycle and shall include the following information:

(1) The name, address, and telephone number of the person requesting the waiver;

(2) The specific rule from which a waiver is requested;

(3) The nature of the waiver requested;

(4) An explanation of all facts relevant to the request for a waiver, including all material facts necessary for the board to evaluate the criteria for granting a waiver as defined in paragraph 11.9(3)"b"; and

(5) A description of any prior communication between the board and the requester relating to the proposed waiver.

d. Ruling. The board shall respond in writing to all requests. The ruling shall include the reason for granting or denying the request. The ruling of the board shall constitute final agency action for the purposes of Iowa Code chapter 17A.

e. Conditions. The board may impose reasonable conditions when granting a waiver in order to achieve the objectives of the particular rule being waived.

f. Violations. If at any time the board finds the facts as stated in the request for a waiver are not true, that material facts have been withheld, or that the requester has failed to comply with conditions set forth in the waiver, the board may initiate disciplinary action in accordance with rule 653--12.50(147,148,17A,272C).

g. Appeals. Any request for an appeal from a decision granting, denying, or canceling a waiver shall be in accordance with the procedures provided in Iowa Code chapter 17A. An appeal shall be made within 30 days of the issuance of the ruling in response to the request for waiver.

h. Public availability. All final rulings in response to requests for waivers shall be indexed and available to members of the public at the board office.

ARC 8134A

Chapter 12 is being amended to clarify the mandatory reporting requirements of licensees.

Notice of Intended Action was published in the April 22, 1998, Iowa Administrative Bulletin as ARC 7958A. One written comment was received and oral comments were made at the June 4, 1998, Board meeting. The adopted amendments are identical to those published under Notice except for the following changes.

The definition of "Knowledge" has been changed from "...causing the licensee to believe that there exists a substantial likelihood the information or evidence that an act or omission occurred is correct" to "...causing the licensee to believe that wrongful acts or omissions may have occurred." The term "Reportable acts or omissions" has been changed to "Reportable conduct" and the wording has been changed to clarify that the requirement covers any state law or rule

over which the Board has jurisdiction. Subrule 12.11(2) has been changed to state that a report shall be filed when the licensee has knowledge that another person licensed by the board may have engaged in reportable conduct. A newparagraph 12.11(2)"d" has been added which states that the requirement does not apply to information gathered byphysician-patient relationship or by information otherwise protected by state and federal law.

These amendments were approved at the June 4, 1998, meeting of the Board of Medical Examiners.

These amendments will become effective August 5, 1998.

These amendments are intended to implement Iowa Code chapters 147, 148, 150, 150A, and 272C.

The following amendments are adopted.

ITEM 1. Rescind rule 653--12.11(272C) and adopt the following new rule in lieu thereof:

653--12.11(272C) Mandatory reporting.

12.11(1) Definitions. For the purposes of this rule, the following definitions apply.

"Knowledge" means any information or evidence of reportable conduct acquired by personal observation, from a reliable or authoritative source, or under circumstances causing the licensee to believe that wrongful acts or omissions may have occurred.

"Reportable conduct" means wrongful acts or omissions that may constitute a basis for disciplinary action under this chapter or any state law or administrative rule that gives the board jurisdiction over the conduct of a licensee.

12.11(2) Reporting requirement. A report shall be filed with the board when a licensee has knowledge as defined in this rule that another person licensed by the board may have engaged in reportable conduct.

a. The report shall be filed with the board no later than 30 days from the date the licensee acquires knowledge of the reportable conduct.

b. The report shall contain the name and the address of the licensee who may have engaged in the reportable conduct, the date, time, place and circumstances in which the conduct occurred, and a statement explaining how knowledge of the reportable conduct was acquired.

c. The final determination of whether or not wrongful acts or omissions have occurred is the responsibility of the board.

d. No licensee is required to report information deemed to be a confidential communication as a result of a physician-patient relationship or which is prohibited by state and federal statute.

ITEM 2. Rescind rule 653--12.12(272C) and adopt the following new rule in lieu thereof:

653--12.12(272C) Failure to report. Failure to report knowledge of wrongful acts or omissions in accordance with rule 12.11(272C) within the required 30-day period shall constitute a basis for the initiation of a board disciplinary action against the licensee who failed to report.

ARC 8133A

This amendment will allow for the use of crossbows for deer and turkey hunting by persons whose physical impairment is of a temporary nature.

Notice of Intended Action was published in the Iowa Administrative Bulletin on April 8, 1998, as ARC 7934A. No comments were received during the comment period or at the public hearing. There are no changes from the Notice of Intended Action.

This amendment is intended to implement Iowa Code section 481A.38.

This amendment will become effective August 5, 1998.

Amend subrule 15.5(1), definition of "Handicapped," as follows:

"Handicapped" means a person possessing a permanent physical impairment of the upper extremities that makes a person physically incapable of shooting a bow and arrow. This includes difficulty in lifting and reaching with arms as well as difficulty in handling and fingering.

ARC 8132A

These amendments create a more efficient way for county recorders to administratively register and issue a certificate of number to used vessels which have never before been registered in Iowa.

Notice of Intended Action was published in the Iowa Administrative Bulletin on April 8, 1998, as ARC 7933A. No comments were received during the comment period or at the public hearing. There are no changes from the Notice of Intended Action.

These amendments are intended to implement Iowa Code section 462A.3.

These amendments will become effective August 5, 1998.

The following amendments are adopted.

ITEM 1. Amend 571--Chapter 38 by striking all references to Iowa Code chapter 106 and inserting 462A to reflect renumbering of the 1993 Iowa Code.

ITEM 2. Amend rule 571--38.6(462A) by adding the following new numbered paragraph "11":

11. If a person is making application for a boat registration number for a used vessel that has never before been registered in Iowa and the person does not have any satisfactory proof of ownership, the county recorder may issue a certificate of number for the used vessel if the applicant has provided the recorder with a signed and notarized affidavit stating that the person making the application is the lawful owner of the vessel.

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